Cholecysto-duodenal fistula as the source of upper gastrointestinal bleeding

Abstract

A 44-year-old woman was admitted with recurrent hematemesis. She had a history of intermittent upper abdominal pain, which was investigated by computed tomography (CT) scan 1 year prior to the presentation ( " Fig. She was taking aspirin for ischemic heart disease. On examination, her heart rate was 110 bpm and she had postural hypotension. She was febrile (38.7 C) and had epigastric tenderness. Blood results were abnormal: white blood cells 17.0 10 3 cells/ L, C-reactive protein 136 mg/L, and alkaline phosphatase 515 IU/L (normal range 70 -300 IU/L). Glasgow-Blatchford and Rockall scores were elevated at 11 and 8, respectively. Findings at gastrointestinal endoscopy and CT scan are shown in