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Papers of the Week

2022 Sep 23

Rev Esp Enferm Dig

A “window” in the duodenal bulb: an atypical presentation of chronic cholecystitis.


Mascarenhas A, Carvalho L, Franco A R, Mendes R, Barreiro P
Rev Esp Enferm Dig. 2022 Sep 23.
PMID: 36148665.


A 74-year-old male presented with melena and fatigue, without fever or abdominal pain. Laboratory examination revealed anemia, leukocytosis, elevated C-reactive protein levels and conjugated hyperbilirubinemia with elevated liver enzymes. Upper endoscopy identified blood in the stomach and duodenum and a 6 mm hole in the anterosuperior surface of the duodenal bulb with spontaneous drainage of a bloody brownish content. The mucosa surrounding the hole was normal and there was a discrete mucosal flap that throbbed with air insufflation. Abdominal computed tomography identified a fistulous tract between the duodenal bulb and the gallbladder with a 2 mm caliber, suggesting a cholecystoduodenal fistula. Diagnosis is often difficult because symptoms are nonspecific and variable but gastrointestinal bleeding is a rare clinical presentation.