Changku Jia, Shaohua Shi, Zhicheng Zhao, Shusen Zheng
Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of College of Medicine Zhejiang University, Hangzhou, 310003 P.R. China.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1372-4.
A 50-year-old man was admitted to our hospital because of a single episode of hematemesis followed by melena for about 14 hours. On gastroendoscopy a 1.2 x 1.4 cm2 deep ulcer was visualized in the back wall of the first part of the duodenum with active bleeding. Digital subtracted angiography showed an obvious leakage of contrast agents from the gallbladder artery. So hemobilia and cholecystoduodenal fistula with upper gastric tract bleeding were diagnosed. Cholecystectomy was performed after the duodenal fistula was resected and repaired. Common bile duct was intubated with a T-tube after no bleeding and stones were verified inside. A pathologic examination confirmed the presence of chronic cholecystitis with the formation of suppurate granulomatosis. The postoperative course was uneventful. He has been doing well without any recurrence of bleeding for the last 7 months.
一名50岁男性因单次呕血伴约14小时黑便入院。胃镜检查发现十二指肠第一部后壁有一个1.2×1.4平方厘米的深部溃疡，伴有活动性出血。数字减影血管造影显示胆囊动脉有明显的造影剂渗漏。因此诊断为胆道出血、胆囊十二指肠瘘伴上消化道出血。在切除并修复十二指肠瘘后进行了胆囊切除术。在确认无出血且胆总管内无结石后，经T形管插管。病理检查证实存在慢性胆囊炎伴化脓性肉芽肿形成。术后过程顺利。在过去7个月里，他情况良好，未再次出血。
