American Journal of Case Reports最新文献

{"title":"Imaging and Diagnostic Challenges in an 11-Year-Old Girl with Vaginal Agenesis: A Case Report.","authors":"Betari Dhira Paramita, Dalri Muhammad Suhartomo, Mochamad Rizkar Arev Sukarsa, Andi Rinaldi, Aria Prasetya Ma'soem, Putri Nadhira Adinda Adriansyah","doi":"10.12659/AJCR.944772","DOIUrl":"10.12659/AJCR.944772","url":null,"abstract":"<p><p>BACKGROUND The prevalence of female genital tract anomalies is around 4-6.9%. Vaginal agenesis is a form of Müllerian agenesis and defined as the congenital absence of the vagina. It affects 1 in 5000 women. During normal fetal development, the Müllerian ducts combine to form the uterus, fallopian tubes, and most of the vagina. However, in cases of vaginal agenesis, the Müllerian ducts fail to fuse to form the upper part of the vagina. This report presents the case of an 11-year-old girl with vaginal agenesis evaluated using ultrasound. CASE REPORT An 11-year-old girl, Tanner stage II, presented with cyclic abdominal pain for 3 months and no menarche. After a hymenectomy for imperforate hymen in January 2023 failed to relieve symptoms, she was referred to our hospital. Physical examination showed a tender lower abdomen with no genital abnormalities. Transabdominal ultrasound was inconclusive for differentiating between a transverse vaginal septum and cervical agenesis with hematometra, and magnetic resonance imaging suggested hematometrocolpos due to a transverse vaginal septum. Intraoperatively, distal vaginal agenesis was identified, and vaginoplasty was performed, evacuating 200 mL of thick blood. The cervix and uterus were normal, and postoperative management included gradual vaginal dilation with a soft mold. This case highlights the diagnostic challenges of distal vaginal agenesis, particularly in patients with a history of imperforate hymen. CONCLUSIONS This report emphasizes the importance of accurate imaging and clinical evaluation in diagnosing reproductive anomalies such as distal vaginal agenesis. Developing techniques to enhance the specificity of imaging modalities is crucial for distinguishing vaginal agenesis from a transverse vaginal septum, ensuring appropriate surgical management and better patient outcomes.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e944772"},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 58-Year-Old Man with a History of Autoimmune Thyroiditis Diagnosed with Mucosa-Associated Lymphoid Tissue Lymphoma and Papillary Carcinoma of the Thyroid.","authors":"Naru Babaya, Sawa Yoshida, Shinsuke Noso, Yoshihisa Hiromine, Yasunori Taketomo, Takayuki Kimura, Hiroaki Kakutani, Takao Satou, Hiroshi Ikegami, Norikazu Maeda","doi":"10.12659/AJCR.946022","DOIUrl":"10.12659/AJCR.946022","url":null,"abstract":"<p><p>BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell non-Hodgkin's lymphoma. Autoimmune (Hashimoto's) thyroiditis is associated with thyroid MALT lymphoma, but co-existence with papillary thyroid carcinoma (PTC) has been less commonly reported. In this case report, we describe a 58-year-old man who presented with a 6-month history of hoarseness and an enlarged thyroid, and was diagnosed with Hashimoto's thyroiditis, MALT lymphoma, and PTC. CASE REPORT Upon referral to our hospital, he presented with an enlarged goiter and hoarseness. Based on preoperative findings, he was diagnosed with Hashimoto's thyroiditis, PTC in the left lobe, and possible malignant lymphoma in both thyroid lobes. However, whether the lymph node swelling around the neck and ¹⁸F-fluorodeoxyglucose uptake on positron emission tomography near the pancreas were related to the PTC, malignant lymphoma, or both remained unclear. Total thyroidectomy and lymph node dissection were performed to treat the PTC and to aid in the diagnosis of malignant lymphoma; the patient was diagnosed with PTC and MALT lymphoma, and lymphadenopathy was attributed to MALT lymphoma. The patient underwent postoperative chemotherapy with rituximab alone, and remission was maintained nearly 3 years after surgery. CONCLUSIONS This report highlights the association between Hashimoto's thyroiditis and thyroid MALT lymphoma, presents a rare finding of coexistent PTC and lymphadenopathy of initially unknown origin, and underscores the importance of histopathology in the diagnosis of these conditions.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946022"},"PeriodicalIF":1.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenosis Masquerading as Endometriosis: A Rare Pelvic Post-Trauma Presentation.","authors":"Khaled Abdul Jawad, Kathryn Denny, Tijani S Osumah, Komal Arora, Sarah E Allen, Christopher J Esper","doi":"10.12659/AJCR.946307","DOIUrl":"10.12659/AJCR.946307","url":null,"abstract":"<p><p>BACKGROUND Splenosis is the ectopic autotrasplantation of splenic tissue that can follow trauma to the spleen or splenectomy and can occur anywhere in the peritoneal cavity or extraperitoneally. Splenosis can present incidentally without symptoms or with various symptoms depending on size and location. We describe a case of pelvic splenosis mimicking endometriosis in presentation. CASE REPORT A 37-year-old woman presented with dyspareunia, dysmenorrhea, and infertility >10 years after a motor vehicle accident requiring splenectomy. Examination revealed suprapubic and uterine tenderness with no retrocervical tenderness or palpable nodularity. Imaging (ultrasound, computed tomography, and magnetic resonance) revealed multiple pelvic masses of unknown etiology concerning for endometriosis, malignancy, or splenosis. Diagnostic laparoscopy with surgical resection of the cul-de-sac masses was performed and pathology confirmed splenosis. The patient reported resolution of her complaints postoperatively, resulting in improved quality of life. CONCLUSIONS Although splenosis is a known condition that can occur after trauma, pelvic splenosis is less often described in the gynecologic literature, leading to diagnostic ambiguity with uterine and ovarian masses as well as endometriosis. We describe a case of splenosis presenting similarly to endometriosis with the aim to improve awareness and diagnostic accuracy of these confounding conditions.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946307"},"PeriodicalIF":1.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Cases of Revisional Urinary Diversion from Ureterocutaneostomy to Ileal Conduit: A Staged Urinary Diversion Strategy for Patients with Bladder Cancer in the Targeted and Immunotherapy Era.","authors":"Yuki Tanaka, Hideki Takeshita, Kazuki Yokota, Sonin Chon, Kenta Fujii, Ayano Ishida, Masahiro Arai, Kojiro Tachibana, Shoichi Nagamoto, Sachi Kitayama, Yohei Okada, Akihiro Yano, Kawakami Satoru","doi":"10.12659/AJCR.946924","DOIUrl":"10.12659/AJCR.946924","url":null,"abstract":"<p><p>BACKGROUND Cutaneous ureterostomy (CU) is a commonly used urinary diversion procedure, particularly for patients with poor prognosis, such as those with advanced cancer, a single kidney, or older age. CU is technically easier and faster to perform than other procedures, such as ileal conduit and ileal neobladder, as it does not involve the intestines, thus reducing the risk of postoperative intestinal complications and metabolic abnormalities. However, CU has several drawbacks, including difficulty in achieving a catheter-free status, frequent urinary tract infections, and concerns about long-term renal function, which can negatively impact a patient's quality of life. Recent advancements in the treatment of advanced metastatic urothelial cancer, particularly with immune checkpoint inhibitors and antibody-drug conjugates, have significantly improved the prognosis of patients with urothelial carcinoma. As a result, some patients who underwent CU and were initially considered to have poor prognosis achieved long-term remission. For these patients, the next goal is to establish a stable urinary diversion method that minimizes management effort and reduces the risk of infection and renal dysfunction. CASE REPORT This report presents 2 cases of revisional urinary diversion from CU to ileal conduit in patients with locally advanced bladder cancer who initially underwent CU and achieved long-term remission with pembrolizumab. Both patients achieved catheter-free status and preserved renal function postoperatively. CONCLUSIONS These cases highlight the potential benefits of staged urinary diversion in improving the quality of life of bladder cancer survivors in an era of targeted immunotherapy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946924"},"PeriodicalIF":1.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Post-Prandial Epigastric Pain Associated with Median Arcuate Ligament Syndrome and Atherosclerosis of the Celiac Trunk in An Elderly Woman: A Case Report.","authors":"Doan Duc Dung, Nguyen The Thoi, Nguyen Huu Thanh, Do Xuan Chien, Manh Duc Ngo, Nguyen Xuan Muoi","doi":"10.12659/AJCR.946075","DOIUrl":"10.12659/AJCR.946075","url":null,"abstract":"<p><p>BACKGROUND Post-prandial abdominal pain due to bowel ischemia can be caused by stenosis (atherosclerosis) or by compression of the arteries of the celiac axis. Median arcuate ligament syndrome (MALS) results from compression at the origin of the celiac trunk by the arcuate ligament. This report describes a 66-year-old woman with chronic post-prandial epigastric pain associated with atherosclerosis of the celiac trunk, managed with angioplasty and stenting combined with MALS. CASE REPORT A 66-year-old female patient with a history of dyslipidemia presented with chronic epigastric pain with post-prandial episodes for 4 years. Two years before the admission, her pain increased with meals and was not relieved by empirical treatment for gastritis. An esophagogastroduodenoscopy and colonoscopy showed chronic gastritis. One year later, a resection of the gastric submucosal tumor was performed, without improving her symptoms. In this presentation, the prompt computed tomography revealed hook-shaped stenosis of the celiac trunk and mild post-stenosis dilatation, highly suggestive of MALS. However, the patient refused to undergo surgery despite the benefit of this intervention. Concurrently, moderately severe atherosclerosis of the celiac trunk was detected during intra-vessel imaging. The patient was treated individually and underwent angioplasty with stenting. At a 5-month follow-up, the patient's condition was stable and she had no gastrointestinal symptoms. CONCLUSIONS Due to the low prevalence and nonspecific symptoms of MALS, physicians should be highly suspicious of this disease, especially in patients with post-prandial abdominal pain. Angioplasty and stenting can be performed in selected patients with MALS and atherosclerosis of the celiac trunk.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946075"},"PeriodicalIF":1.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Traumatic Thyroid Cartilage Fracture from Sudden Neck Motion: Clinical Insights.","authors":"Pierre Attal, Ben-Zion Horwitz, Jen-Yves Sichel, Chanan Shaul","doi":"10.12659/AJCR.946084","DOIUrl":"10.12659/AJCR.946084","url":null,"abstract":"<p><p>BACKGROUND The thyroid cartilage is the most prominent laryngeal cartilage located beneath the hyoid bone. Non-traumatic fractures of the larynx, including the thyroid cartilage, are rare and can occur when the glottis is closed and intrathoracic pressure suddenly increases. This report describes the case of a 42-year-old man presenting with hoarseness and pain when swallowing and a diagnosis of non-traumatic thyroid cartilage fracture following sudden neck movement, highlighting the importance of recognizing atypical mechanisms of laryngeal injury. CASE REPORT A 42-year-old healthy man experienced a \"pop\" in his neck during sudden sharp head turning while driving. Five days later, he presented to the hospital with progressive odynophagia and hoarseness. Initial diagnostic workup included computed tomography imaging, which revealed a non-displaced anterior thyroid cartilage fracture with surrounding air. Fiberoptic laryngoscopy demonstrated left vocal cord thickening with preserved mobility, and a barium swallow study was unremarkable. Based on these findings and stable airway status, conservative management was initiated with antibiotics and airway monitoring. The patient was discharged after 2 days and demonstrated complete symptom resolution at 1-month follow-up. CONCLUSIONS This report has presented a rare case of non-traumatic thyroid cartilage fracture following sudden neck motion. The case highlights the importance of careful history and imaging of the structures of the neck, particularly in patients presenting with voice changes, even without apparent trauma. Furthermore, it supports the efficacy of conservative management in stable, non-displaced laryngeal fractures.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946084"},"PeriodicalIF":1.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providencia rettgeri and Group G Streptococcus in Anorexia Nervosa-Related Empyema: A Case Report.","authors":"Atsunori Hiasa, Ichiro Imoto, Hideki Nomura, Toshiaki Takeuchi, Moriharu Misaki, Taro Yasuma, Corina N D'Alessandro-Gabazza, Esteban C Gabazza, Hiroyuki Nishimura","doi":"10.12659/AJCR.945029","DOIUrl":"10.12659/AJCR.945029","url":null,"abstract":"<p><p>BACKGROUND Anorexia nervosa, predominantly affecting young females, significantly compromises the immune system, rendering patients vulnerable to infections and contributing to a notably high mortality rate. The complexities involved in managing infections in immunocompromised patients with anorexia nervosa are often underappreciated. This case report aims to shed light on these challenges and the potential complications arising from treatment interventions. CASE REPORT We present the case of a 30-year-old woman with a long-standing history of anorexia nervosa, who was admitted with severe systemic symptoms, including profound weakness and numbness in her extremities. Initial laboratory tests revealed severe renal failure and marked dyselectrolytemia. On day 14 of hospitalization, the patient developed empyema thoracis, an uncommon but severe complication in patients with anorexia nervosa. The empyema was caused by Providencia rettgeri and group G Streptococcus, suggesting aspiration of oral secretion was the etiology. Despite appropriate antibiotic therapy, the condition recurred, likely exacerbated by the administration of corticosteroids to manage concurrent thrombocytopenia, which further compromised the patient's already weakened immune system. CONCLUSIONS This case underscores the critical need for careful consideration of the immunosuppressive effects of treatments like corticosteroids in anorexia nervosa patients, who are already at heightened risk for severe infections such as empyema thoracis. It highlights the importance of vigilant monitoring and tailored management strategies for infections in these patients, emphasizing a multidisciplinary approach to optimize outcomes in similar clinical scenarios. The case provides valuable insights into balancing the benefits and risks of immunosuppressive therapies in the management of anorexia nervosa and associated complications.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945029"},"PeriodicalIF":1.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing and Managing Post-Lobectomy Lung Torsion: A Critical Case Report.","authors":"Tinglv Fu, Ning Li, Qing Geng","doi":"10.12659/AJCR.945744","DOIUrl":"10.12659/AJCR.945744","url":null,"abstract":"<p><p>BACKGROUND Lung torsion is very rare but is a recognized postoperative complication of lobectomy of the lung. This report describes the case of a 63-year-old woman with lung torsion of the left lower lobe following left upper lobe resection for lung neoplasms who required an emergency completion pneumonectomy. CASE REPORT The patient was a 63-year-old woman who underwent thoracoscopic left upper lobectomy after excluding distant metastasis, due to a mixed-density mass in the left upper lobe of the lung. After surgery, the patient's chest pain progressively worsened. On the third postoperative day, she also had symptoms such as chest tightness, atrial fibrillation, tachycardia, and leukocytosis, but no dyspnea. Then, an urgent contrast-enhanced chest computed tomography revealed diffuse ground-glass attenuation in the left lower lobe and a left lower bronchial obstruction. It also revealed that the left inferior pulmonary artery was twisted upward with distal poor filling. A bedside electronic bronchoscopy also found that the left lower lobe bronchus was obviously narrowed and almost completely occluded. Due to high suspicion of left lower lobe torsion, emergency surgery was performed. During the operation, it was found that the left lower lobe had rotated 180° counterclockwise. After evaluating the poor lung vitality, a left lower lobectomy of the lung was performed. The patient recovered well after the operation and no complications occurred during follow-up. CONCLUSIONS This report has highlighted the importance of postoperative imaging following left upper lobectomy; although left lower lobe torsion is a rare complication, it is a potentially life-threatening condition that requires emergency pneumonectomy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945744"},"PeriodicalIF":1.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valve-in-Valve Transapical Transcatheter Aortic Valve Replacement with Concomitant Percutaneous Coronary Intervention: A Case Report.","authors":"Abeline R Watkins, Ryaan El-Andari, Anoop Mathew, Jeevan Nagendran","doi":"10.12659/AJCR.946582","DOIUrl":"10.12659/AJCR.946582","url":null,"abstract":"<p><p>BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is increasingly used, as older high-risk patient populations require repeat aortic valve replacements. The most common approach to ViV-TAVR is through a transfemoral approach or alternative vascular access sites, such as transcarotid or transsubclavian TAVR. Within this population, some patients become ineligible for ViV-TAVR due to contraindications, such as severe peripheral vascular disease, necessitating an alternative. Transapical TAVR allows for TAVR even in the context of severe peripheral vascular disease, although it has rarely been used in the ViV-TAVR setting, and even less frequently with concomitant percutaneous coronary intervention. CASE REPORT We present the case of a 79-year-old man with a history of coronary artery disease and aortic valve disease 9 years after coronary artery bypass grafting and aortic valve replacement presenting with progressive dyspnea on exertion. The patient was found to have severe prosthetic valve degeneration but had a high preoperative surgical risk score and severe peripheral arterial disease. Transfemoral, carotid, and subclavian access were contraindicated given the severe vascular disease, and therefore the patient underwent transapical ViV-TAVR with a 26-mm Sapien S3 valve and a left main coronary artery snorkel stent for protection of the left main coronary. CONCLUSIONS With this rare documented case of transapical ViV-TAVR, we highlight the importance of having several available alternative surgical approaches to TAVR for patients who are ineligible for transfemoral ViV-TAVR and have high preoperative risk scores.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946582"},"PeriodicalIF":1.0,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholecystoduodenal Fistula Due to Gallstone Disease Masquerading as a Duodenal Ulcer Bleed: A Case Report.","authors":"Jayati Churiwala, Hemant Sheth, Esam Aboutaleb","doi":"10.12659/AJCR.946743","DOIUrl":"10.12659/AJCR.946743","url":null,"abstract":"<p><p>BACKGROUND A cholecystoenteric fistula (CEF) is a rare complication of gall stone disease. While a cholecystoduodenal fistula is the most commonly occurring bilioenteric fistulous communication, cholecystocolonic, cholecystogastric and choledochoduodenal fistulas have also been described. CASE REPORT A 73-year-old woman presented with a 1-week history of melena on a background of acid reflux and no abdominal pain. A gastroscopy revealed kissing D1 ulcers with excretion of pus. Following a CT scan of the abdomen, the patient was referred to the surgical team for the management of acute cholecystitis with a cholecystoduodenal fistula. She underwent an open cholecystectomy with fistula take-down and repair of the duodenum in the same admission. Following an uneventful postoperative recovery, she was discharged on an empirical course of H. pylori eradication therapy. Recurrent episodes of acute cholecystitis or chronic cholecystitis can lead to adhesions between the gall bladder and adjacent viscus. Gall stone impaction then can cause pressure necrosis, leading to a fistulation between the gall bladder and the viscus. Rarely, this presents with massive upper-gastrointestinal bleeding. Imaging with ultrasound can reliably diagnose cholelithiasis, cholecystitis, and pneumobilia, but is unlikely to help in the definitive diagnosis of a bilioenteric fistula, which requires cross-sectional imaging. CONCLUSIONS Massive upper-gastrointestinal bleeding is a rare mode of presentation of CEF. Hemodynamic resuscitation and management of upper-GI bleed takes precedence, followed by definitive management of the CEF after establishment of the diagnosis.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946743"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}