Year 2022 / Volume 114 / Number 12
Letter
A “window” in the duodenal bulb: an atypical presentation of chronic cholecystitis

771-772

DOI: 10.17235/reed.2022.9174/2022

André Mascarenhas, Liliana Carvalho, Ana Rita Franco, Raquel Mendes, Pedro Barreiro,

Abstract
A 74-year-old male presented with melena and fatigue, without fever or abdominal pain. Laboratory examination revealed anemia, leukocytosis, elevated C-reactive protein levels and conjugated hyperbilirubinemia with elevated liver enzymes. Upper endoscopy identified blood in the stomach and duodenum and a 6 mm hole in the anterosuperior surface of the duodenal bulb with spontaneous drainage of a bloody brownish content. The mucosa surrounding the hole was normal and there was a discrete mucosal flap that throbbed with air insufflation. Abdominal computed tomography identified a fistulous tract between the duodenal bulb and the gallbladder with a 2 mm caliber, suggesting a cholecystoduodenal fistula. Diagnosis is often difficult because symptoms are nonspecific and variable but gastrointestinal bleeding is a rare clinical presentation.
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References
1. Aguilar-Espinosa F, Maza-Sánchez R, Vargas-Solís F, Guerrero-Martínez GA, Medina-Reyes JL, Flores-Quiroz PI. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. Fístula colecistoduodenal, complicación infrecuente de litiasis vesicular: nuestra experiencia en su manejo quirúrgico. Rev Gastroenterol Mex. 2017 Apr;82(4):287–295.
2. Cao YH, Qiao ZG, Xu D. Cholecystoduodenal fistula: An uncommon cause of massive hemorrhage of upper gastrointestinal tract. Kaohsiung J Med Sci. 2021 May;37(5):436–437.
3. Chen CC, Wang SC, Chen TH, Chou SJ, Lan HC. A Rare Case of Cholecystoduodenal Fistula Complicated With Gallstone Ileus and Upper Gastrointestinal Bleeding. Cureus. 2022 May;14(5):e24846.
4. Wang HY, Yang XX, Guo SJ. Spontaneous proximal choledochoduodenal fistula, a rare complication of cholangiolithiasis. Rev Esp Enferm Dig . 2021 Jan;113(1):74–75.
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Mascarenhas A, Carvalho L, Franco A, Mendes R, Barreiro P. A “window” in the duodenal bulb: an atypical presentation of chronic cholecystitis. 9174/2022


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Publication history

Received: 31/08/2022

Accepted: 02/09/2022

Online First: 23/09/2022

Published: 12/12/2022

Article Online First time: 23 days

Article editing time: 103 days


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