Gastrointestinal: Cholecystoduodenal fistula with gallstone-induced intestinal obstruction

摘要

An 89-year-old man presented with upper abdominal pain, nausea and vomiting. He had a history of angina pectoris, osteoarthritis and prostate cancer and was initially managed at the urology department. Hematocrit and liver function tests were normal. The patient's symptoms rapidly deteriorated and five days later was an upper gastrointestinal endoscopy performed revealing subtle erosions in the esophagus and a dilated stomach with fluid retention. The mucosa in the stomach and duodenum was markedly swollen and inflamed. Moreover, a 2x2 cm large fistula was detected in the duodenal bulb (Figure 1). An obstructing, several centimeter in size, yellow-brownish foreign object was detected in the dilated descending duodenum (Figure 2). Several attempts to endoscopi-cally extract the foreign object failed (Figure 3) and the patient underwent open surgery. An 8x5 cm large gallstone was removed via a duodenotomy and the patients recovered uneventfully.