Abstract
Background: Peptic duodenal ulceration (DU) is a common cause for upper gastrointestinal bleeding, and usually affects the duodenal bulb. Post-bulbar DU is unusual and may rarely be caused by a cholecystoduodenal fistula (CCDF). Methods & Observations: We report a 66-year-old patient who presented with haematemesis and was found to have a postbulbar bleeding DU that was managed by endoscopic intervention. Seven weeks later, he presented with a gallstone ileus, and was managed successfully with laparoscopy enterolithotomy. A barium study demonstrated a CCDF at the site of the previously detected DU. Conclusion: Impending CCDF secondary to a large gallstone ought to be considered as a cause for an unusually sited bleeding DU in elderly patients. Consideration may then be given to an elective management of the cholecystolithiasis with percutaneous lithotripsy and dissolution therapy in the surgically unfit patient or with a laparoscopic cholecystectomy and closure of the CCDF.
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