Case Report: Cystic artery peptic erosion: Uncommon cause of massive upper gastrointestinal bleeding.

<ns3:p>Introduction and importance The cholecystoenteric fistula, a rare complication of cholelithiasis, usually occurs as an internal biliary fistula. Our case features a cholecystoduodenal fistula presenting with severe upper gastrointestinal bleeding originating from the cystic artery. Symptoms vary, and preoperative diagnosis is uncommon. Case presentation A 63-year-old diabetic patient, who had undergone surgical treatment for a left forearm fracture, presented with persistent bleeding, hematemesis, and melena. Diagnostic esophagogastroduodenoscopy revealed an actively bleeding ulcer on the duodenal bulb, with an attempted hemostasis. Initial stabilization was achieved, but a recurrence occurred after 17 hours with hemodynamic instability. Emergency laparotomy revealed cholecystitis with a cholecystoduodenal fistula, necessitating cholecystectomy and ulcer resection. The source of bleeding was the cystic artery. The patient had a positive postoperative outcome with no recurrence of hemorrhage. Clinical discussion Cholecystoenteric fistulas, forming from obstructed cystic duct inflammation, are rare complications of biliary lithiasis. Most cases are spontaneous, linked to gallstones. Severe upper gastrointestinal bleeding from cholecystoduodenal fistulas is uncommon, often requiring surgical intervention due to cystic artery erosion. Despite advancements in laparoscopic methods, open operations are preferred for anatomical distortion and inflammation. A clear diagnosis involves hepatic angiography and may necessitate embolization. The rarity of this condition emphasizes the need for vigilant diagnosis, especially in patients with gallstone history. Conclusion Massive bleeding from cystic artery erosion by duodenal ulcer through cholecystoduodenal fistula underscores the need for clinicians’ vigilance. Recognition of gallstone disease history is crucial for timely diagnosis in this rare cause of gastrointestinal bleeding.</ns3:p>