engleski

UPPER GASTROINTESTINAL (Gl) BLEEDING LIKE A LEADING SIMPTOM OF CHOLECYSTODUODENAL FISTULA WITH IMPACT GALLSTONE INTO THE DUODENUM

Biliary-enteric fistula usualy folow ah episode of acute cholecystitis with gangrene and perforation of the gallbladder wall into the adjacent viscus (75% duodenum) or result from pressure necrosis from an impacted gallstone. Most commonly, gallstone evacuate spontaneusly vvith stool, less commonly develop mechanical obstruction' of duodenum (Bouveret-ov syndrom) or small intestin (Gallstone ileus). Rarely ; gallstone may be the cause of Gl bleeding.VVe preseht a female pacient, 66 years old, with sings and symptoms of Gl bleeding (hematemesis et melena) and right upper quadrant abdominal pain.After initial management of the pacient (general'evaluation and resuscitatior] ; ), diagnosis manegment include upper endoscopy, US, CT and MR. Upper en<|pscopy find, bleeding into the second part of duodenum, vvith'out egzact locationfUS, CT and MR of abdomen demostrated mass betvveen gallbladder and duodenum, with cholelithiasis and pneumocholecyst. Open exploartion finded inflamatory process vvithin the subhepatic space and gallblader- duodenal fistula vvith impacted gallstone into the duodenum. After ćholecystectomy and takedovvn of fistula, duodenum was opened and thre calculus vvas extracted.The postoperativ course vvas without a complicacions. Conclusion: Nontreated calculous cholecystitis wich biliary-duodenal fistula and impacted gallstone into the duodenum could be the one of the conditions in differential diagnosis of upper Gl bleeding.

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