A Complicated Peptic Ulcer With Bleeding, Gastric Outlet Obstruction, and Choledochoduodenal Fistula

Yadav, Tek Narayan; Deo, Kunal Bikram; Gautam, Sujan; Awale, Laligen; Pandit, Narendra

doi:10.7759/cureus.11189

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Among the 10 included case reports, four were written in the United States of America ( 10 – 13 ), three in Europe ( 14 – 16 ), one in Nepal ( 17 ), one in India ( 18 ) and one in Egypt ( 19 ) ( Table 1 ). In total, 11 cases were reported.…”

Section: Resultsmentioning

confidence: 99%

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

Uhe¹,

Litchinko²,

Liot³

2023

Front. Surg.

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Peptic ulcer disease (PUD) is a very common condition, with an annual incidence ranging from 0.1% to 0.3% and a lifetime prevalence ranging from 5% to 10%. If not treated, it can lead to severe complications such as gastro-intestinal bleeding, perforation, or entero-biliary fistula. Entero-biliary fistulas and especially choledocho-duodenal fistula (CDF) are a rare, but relevant and important diagnosis, which can lead to several complications such as gastric outlet obstruction, bleeding, perforation, or recurrent cholangitis. In this article, we present the case of an 85-year-old woman with PUD complicated with gastro-intestinal bleeding and a CDF. We also performed a review of the literature to search for pre-existing cases with this atypical clinical presentation. The aim was to raise awareness among surgeons and clinicians by offering a summary of different types of entero-biliary and especially CDF, existing diagnostic investigations, and management.

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Section: Resultsmentioning

confidence: 99%

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

Uhe¹,

Litchinko²,

Liot³

2023

Front. Surg.

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“…It is indicated in patients with re-bleeding or hemodynamic instability despite fluid therapy and blood transfusion [21] . Emergency surgery is currently only suitable for perforations, patients who fail non-surgical therapy, and those who remain hemodynamically unstable despite aggressive resuscitation [22] . In our study, emergency surgical intervention was performed in patients whose bleeding could not be controlled by endoscopic intervention and those who did not accept endoscopic intervention.…”

Section: Discussionmentioning

confidence: 99%

“…[21] Emergency surgery is currently only suitable for perforations, patients who fail non-surgical therapy, and those who remain hemodynamically unstable despite aggressive resuscitation. [22] In our study, emergency surgical intervention was performed in patients whose bleeding could not be controlled by endoscopic intervention and those who did not accept endoscopic intervention. Since interventional radiology is only available in certain centers, surgical intervention is more prominent in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Akay

Leblebici

2021

Medicine

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Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB. Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0–2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2–4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64). Early bleeding and permanent hemostasis were higher in Group 2 ( P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups ( P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 ( P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively. In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.

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Gallstone ileus in a middle-aged male with an atypical history: a case report

Vinnik

Teplyakova

Volkov

et al. 2022

Acta biomedica scientifica

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Currently, gallstone ileus is an unusual complication of cholelithiasis (0.3–3.0 %) and a rare cause of mechanical bowel obstruction (0.1–4.0 %). The rarity of the condition makes it impossible to plan the large prospective randomized clinical trials, so the analysis of case reports is significant for decision making in the management of gallstone ileus. We report a case of gallstone ileus in a middle-aged male who had a history of surgery for duodenal ulcer perforation in past. A combination of peptic ulcer disease and cholelithiasis is based on a reduced gastrointestinal hormones secretion. Clinical specialists need to consider information about the greater frequency and asymptomatic clinical course of gallstone disease against a background of duodenal ulcer. Duodenal ulcer scar and bulbar deformity may promote to the cholecystoduodenal fistula formation. In the presence of an acute bowel obstruction symptoms and the absence of gallbladder instrumental examination results, it is possible to recommend the prior gastroduodenoscopy for the pre-operative pneumobilia detection. The optimal surgical approaches for acute gallstone ileus are still controversial.

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A Complicated Peptic Ulcer With Bleeding, Gastric Outlet Obstruction, and Choledochoduodenal Fistula

Cited by 3 publications

References 16 publications

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Gallstone ileus in a middle-aged male with an atypical history: a case report

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