PT  - JOURNAL ARTICLE
AU  - Dinesh Kumar Vadioaloo
AU  - Guo Hou Loo
AU  - Voon Meng Leow
AU  - Manisekar Subramaniam
TI  - Massive upper gastrointestinal bleeding: a rare complication of cholecystoduodenal fistula
AID  - 10.1136/bcr-2018-228654
DP  - 2019 May 01
TA  - BMJ Case Reports
PG  - e228654
VI  - 12
IP  - 5
4099  - http://casereports.bmj.com/content/12/5/e228654.short
4100  - http://casereports.bmj.com/content/12/5/e228654.full
SO  - BMJ Case Reports2019 May 01; 12
AB  - A biliary fistula which may occur spontaneously or after surgery, is an abnormal communication from the biliary system to an organ, cavity or free surface. Spontaneous biliary-enteric fistula is a rare complication of gallbladder pathology, with over 90% of them secondary to cholelithiasis. Approximately 6% are due to perforating peptic ulcers. Symptoms of biliary-enteric fistula varies widely and usually non-specific, mimicking any chronic biliary disease. Cholecystoduodenal fistula causing severe upper gastrointestinal (UGI) bleed is very rare. Bleeding cholecystoduodenal fistula commonly requires surgical resection of the fistula and repair of the duodenal perforation. We describe the case of a previously healthy older patient who initially presented with symptoms suggestive of UGI bleeding. Bleeding could not be controlled endoscopically. When a laparotomy was performed, a cholecystoduodenal fistula was discovered and bleeding was noted to originate from the superficial branch of cystic artery.