Massive upper gastrointestinal bleeding: a rare complication of cholecystoduodenal fistula

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery

Background:

• Biliary fistulas are abnormal connections involving the biliary system, often arising from gallbladder disease or peptic ulcers.
• Spontaneous biliary-enteric fistulas are rare, with cholelithiasis being the most common cause.

Observation:

• A previously healthy older patient presented with symptoms mimicking upper gastrointestinal (UGI) bleeding.
• Endoscopic management failed to control the bleeding.
• A cholecystoduodenal fistula was discovered during laparotomy, with bleeding originating from the cystic artery.

Findings:

• Severe UGI bleeding was attributed to a cholecystoduodenal fistula.
• The bleeding source was identified as the superficial branch of the cystic artery.
• Surgical resection and repair were necessary due to the rarity and severity of the condition.

Implications:

• This case highlights the rare but serious complication of bleeding cholecystoduodenal fistula.
• It underscores the importance of considering biliary pathology in unexplained UGI bleeding.
• Effective management often requires surgical intervention for fistula and duodenal repair.