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October 1968

Massive Upper-Gastrointestinal Tract HemorrhageA Complication of Cholecystoduodenal Fistula

Author Affiliations

From the Department of Surgery, Harvard Medical School and the General Surgical Services, Massachusetts General Hospital, Boston.

Arch Surg. 1968;97(4):531-532. doi:10.1001/archsurg.1968.01340040027001

GALLSTONE ileus as a complication of cholecystoduodenal fistula, and its surgical management, has been well emphasized in the literature. Massive upper-gastrointestinal tract hemorrhage as a result of a cholecystoenteric fistula is a rare entity.1,2 Erosion of the cystic artery from a gallstone perforation of the duodenum presenting as hematemesis has not been previously reported. The following case reports illustrate this unusual occurrence.

Report of Cases  Case 1 (MGH-32961).—An 81-year-old woman was admitted to the Massachusetts General Hospital in June 1967 with a one-week history of epigastric pain and hematemesis on the day of admission. She had been in good general health except for mild symptoms of congestive heart-failure diagnosed on the basis of the presence of arteriosclerotic heart disease. There was no past history of abdominal pain, fatty-food intolerance, or jaundice.On admission, the patient's blood pressure and pulse were normal. She had no jaundice. There was

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