A 75-year-old man presented with a 3-week history of melaena and right upper quadrant pain. This was on a background of significant alcohol intake and a complex medical history. He was haemodynamically unstable with investigations indicating a new iron-deficiency anaemia. After resuscitation, urgent intervention was required under general anaesthesia. This involved a triple phase abdominal CT, followed by emergency oesophagogastroduodenoscopy. This revealed deep ulceration with extension to the pancreatic head and common bile duct. There was also evidence of pneumobilia on CT, secondary to a choledochoduodenal fistula. Treatment encompassed an invasive and medical approach. Following treatment, the patient was stable, with follow-up endoscopy exhibiting good duodenal mucosal healing.
- GI bleeding
- pancreas and biliary tract
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Contributors SK contributed to the clinical care and endoscopic management of the case. SK, MV, PG and SS contributed to the clinical analysis, write up and review of the case, endoscopy and radiological images. All authors contributed to review of the final manuscript. MV is the corresponding author and SK is the guarantor of the work.
Funding This study was funded by Imperial College Healthcare NHS Trust (949113).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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