Open AccessA �window� in the duodenal bulb: an atypical presentation of chronic cholecystitis
Author(s) -
André Mascarenhas,
Liliana Carvalho,
Ana Rita Franco,
Raquel Mendes,
Pedro Barreiro
Publication year - 2022
Publication title -
revista española de enfermedades digestivas/revista española de enfermedades digestivas
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.331
H-Index - 38
eISSN - 2340-4167
pISSN - 1130-0108
DOI - 10.17235/reed.2022.9174/2022
Subject(s) - medicine , duodenal bulb , melena , duodenum , leukocytosis , cholecystitis , gastroenterology , abdominal pain , gallbladder , duodenal diseases , cholecystectomy , abdomen , surgery
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.