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Cholecystoduodenal fistula accompanied by bleeding from the upper gastrointestinal tract (clinical case)

https://doi.org/10.20340/vmi-rvz.2025.1.CASE.4

Abstract

Introduction. Cholecystoduodenal fistula is a rare complication of cholelithiasis and extremely rarely manifests as massive bleeding from the upper gastrointestinal tract. Only 15 similar clinical cases have been described in the world literature. Objective: To present a clinical case of a biliodigestive fistula complicated by upper gastrointestinal bleeding, and to analyze the features of diagnosis and treatment of this pathology. Materials and methods. A clinical case of a 62-year-old patient with cholelithiasis complicated by cholecystoduodenal fistula and massive gastrointestinal bleeding is described. An analysis of literature data with systematization of 15 similar cases was conducted. Results. A patient with a known history of cholelithiasis and biliodigestive fistula developed massive bleeding from the upper gastrointestinal tract with hemorrhagic shock. Endoscopic examinations revealed a fixed hemorrhagic clot and a duodenal bulb ulcer. Despite conservative therapy and endoscopic hemostasis, on the 8th day, rebleeding occurred requiring emergency surgical intervention. Intraoperatively, cholecystoduodenal and cholecystotransverse fistulas with ongoing bleeding were identified. A 2/3 gastric resection with Roux-en-Y reconstruction, cholecystectomy, and right hemicolectomy were performed. Conclusion. Cholecystoduodenal fistula complicated by bleeding requires surgical treatment, as significant bleeding from large arteries is rarely eliminated by conservative treatment or endoscopic hemostasis. The presented case is the 16th in world surgical practice, which emphasizes the need for further study of this pathology and the development of effective treatment methods.

About the Authors

V. M. Manuylov
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Vladimir M. Manuylov - Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation, Chief Physician of the Pushkin Clinical Hospital named after prof. V.P. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



A. N. Shcherbyuk
Pushkin Clinical Hospital named after prof. V.N. Rozanov; Moscow Medical University "Reaviz"
Russian Federation

Aleksandr N. Shcherbyuk - Dr. Sci. (Med.), Professor, Head of the Scientific and Clinical Department, Pushkin Clinical Hospital named after prof. V.P. Rozanov, Professor of the Department of Surgical Diseases, Moscow Medical University "Reaviz".

35, Aviatsionnaya str., Pushkino, 141206; 2, Krasnobogatyrskaya str., building 2, Moscow, 107564
Competing Interests:

None



D. A. Tsarev
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Daniil A. Tsarev - Proctologist, surgeon, hospital #2, Pushkin Clinical Hospital named after prof. V.N. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



Yu. I. Zakharov
Moscow Regional Research Clinical Institute named after M.F. Vladimirsky
Russian Federation

Yuriy I. Zakharov - Cand. Sci. (Med.), surgeon, senior researcher, abdominal surgery department, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

61/2, Shchepkina str., Moscow, 129110
Competing Interests:

None



Ya. E. Nemstsveridze
Moscow Medical University "Reaviz"; Moscow Regional Research Clinical Institute named after M.F. Vladimirsky
Russian Federation

Yakov E. Nemstsveridze - Specialist of the Research and Innovation Department, Moscow Medical University "Reaviz"; dentist, resident physician of the Department of Orthopedic Dentistry, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky.

2, Krasnobogatyrskaya str., building 2, Moscow, 107564; 61/2, Shchepkina str., Moscow, 129110
Competing Interests:

Nemstsveridze Ya.E. is the scientific editor of the journal; he did not participate in the decision to publish the work.



A. V. Mokhov
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Andrey V. Mokhov - Cand. Sci. (Med.), Head of the Surgical Department, Hospital No. 2, Pushkin Clinical Hospital named after prof. V.N. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



D. A. Mokhov
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Dmitriy A. Mokhov - Surgeon, Hospital No. 2, Pushkin Clinical Hospital named after prof. V.N. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



E. Yu. Nabieva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Elena Yu. Nabieva - 4th year student of General Medicine, First Moscow State Medical University named after I. M. Sechenov (Sechenov University).

8 Trubetskaya str., Bldg. 2, Moscow, 119048
Competing Interests:

None



S. S. Karpina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Sofiya S. Karpina - 2nd year student of General Medicine, First Moscow State Medical University named after I.M. Sechenov (Sechenov University).

8 Trubetskaya str., Bldg. 2, Moscow, 119048
Competing Interests:

None



U. O. Gafarov
Pushkin Clinical Hospital named after prof. V.N. Rozanov; Moscow City Scientific and Practical Center for the Fight against Tuberculosis
Russian Federation

Umedzhon O. Gafarov - Cand. Sci. (Med.), Surgeon, Pushkin Clinical Hospital named after prof. V.N. Rozanov; Moscow City Scientific and Practical Center for the Fight against Tuberculosis.

35, Aviatsionnaya str., Pushkino, 141206; 10, Stromynka str., Moscow, 107014
Competing Interests:

None



A. V. Peretechikov
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Aleksandr V. Peretechikov - Cand. Sci. (Med.), Deputy Chief Physician for Surgery, Surgeon, Hospital No. 2, Pushkin Clinical Hospital named after prof. V.N. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



A. P. Yunkin
Pushkin Clinical Hospital named after prof. V.N. Rozanov
Russian Federation

Anton P. Yunkin - Head of the Pathological Anatomy Department, Pathologist, Hospital No. 2, Pushkin Clinical Hospital named after prof. V.N. Rozanov.

35, Aviatsionnaya str., Pushkino, 141206
Competing Interests:

None



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Review

Представленная статья посвящена редкому и клинически значимому осложнению желчнокаменной болезни – холецистодуоденальному свищу, осложненному кровотечением из верхних отделов желудочно-кишечного тракта.

Положительные аспекты:

  1. Авторы представили исключительно редкий клинический случай (16-й в мировой практике), что определяет научную ценность публикации для хирургического сообщества.
  2. Работа содержит детальное описание клинического течения, диагностических мероприятий и хирургического лечения.
  3. Проведен тщательный анализ мировой литературы с обобщением данных о 15 ранее опубликованных случаях.
  4. Статья имеет четкую структуру, соответствующую требованиям к публикациям клинических случаев.

Замечания:

  1. Желательно более подробно описать дифференциально-диагностический поиск на диагностическом этапе.
  2. Недостаточно информации о катамнезе пациента: отдаленные результаты и возможные осложнения.
  3. Было бы полезно включить обсуждение тактики ведения послеоперационного периода у подобных пациентов.
  4. Интерпретация визуальных материалов (схем и рисунков) требует более детального пояснения.

Заключение: Статья представляет значительный научно-практический интерес для хирургов, гастроэнтерологов и эндоскопистов. Материал хорошо структурирован и основан на редком клиническом наблюдении. Рекомендую статью к публикации после незначительной доработки с учетом указанных замечаний.

Работа вносит ценный вклад в понимание диагностики и лечения редкого и потенциально жизнеугрожающего осложнения желчнокаменной болезни.

For citations:

Manuylov V.M., Shcherbyuk A.N., Tsarev D.A., Zakharov Yu.I., Nemstsveridze Ya.E., Mokhov A.V., Mokhov D.A., Nabieva E.Yu., Karpina S.S., Gafarov U.O., Peretechikov A.V., Yunkin A.P. Cholecystoduodenal fistula accompanied by bleeding from the upper gastrointestinal tract (clinical case). Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH). 2025;15(1):123-129. (In Russ.) https://doi.org/10.20340/vmi-rvz.2025.1.CASE.4

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