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Upper gastrointestinal bleeding: gallstone-induced auto-sphincterotomy.

Sujala Kalipershad¹, Kin Tong Chung, Ernest Jehangir

¹Department of Surgery, North Cumbria University Hospitals NHS Trust, West Cumberland Hospital, Whitehaven, UK.

BMJ Case Reports

|August 24, 2012

Summary

A rare case of upper gastrointestinal bleeding was caused by a gallstone that eroded the duodenal papilla. This condition, gallstone-induced auto-sphincterotomy, was diagnosed during surgery after initial tests were inconclusive.

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Area of Science:

Gastroenterology
Abdominal Surgery
Diagnostic Imaging

Background:

Unexplained upper gastrointestinal bleeding (UGIB) presents a diagnostic challenge.
Gallstone disease is common, but its direct causation of UGIB via sphincterotomy is rare.

Observation:

A 67-year-old male presented with acute epigastric pain, coffee-ground emesis, and melena.
Initial investigations (blood tests, ultrasound, CT, endoscopy) failed to identify the bleeding source.
A second CT scan revealed contrast extravasation into the duodenum, suggesting a leak.

Findings:

Exploratory laparotomy and jejunostomy were performed due to persistent bleeding.
Intraoperative duodenoscopy identified a large gallstone within the duodenum.
The papilla of Vater was found to be ruptured, confirming gallstone-induced auto-sphincterotomy.

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Implications:

This case highlights the importance of considering rare etiologies for obscure UGIB.
Gallstone-induced auto-sphincterotomy should be suspected in patients with unexplained bleeding and gallstone history.
Advanced imaging and intraoperative endoscopy are crucial for diagnosing such unusual presentations.