Sarmento Costa M, Gravito-Soares M, Gravito-Soares E, Figueiredo P. Unexpected cause of upper gastrointestinal bleeding: beyond the typical complications of gallstone disease.
REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID:
38205688 DOI:
10.17235/reed.2024.10134/2023]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
An 88-year-old man presented with haematemesis with haemodynamic stability requiring transfusion of 5 units of blood. Physical examination was unremarkable. Upper endoscopy identified a fistulous opening in the proximal second part of the duodenum (D2) with an oozing bleed and blood clots. A computed tomography (CT)-angiogram revealed a 18mm cystic artery pseudoaneurysm next to a fistulous communication between the gallbladder and D2, allowing the passage of a large stone (Bouveret syndrome). The patient successfully underwent emergent arterial embolization guided by a clip endoscopically-placed near the duodenal fistulous orifice. There were no intercurrences or bleeding recurrence.
Collapse