Gastrohepatic fistula as a rare complication in peptic ulcer disease: A case report and review of the literature

Rationale: Peptic ulcer disease (PUD) remains a significant health concern, affecting approximately 5% to 10% of the population despite declining prevalence. Uncontrolled use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a major risk factor. Among PUD complications, fistula formation is rare. This report presents a unique case of a gastrohepatic fistula secondary to PUD in a young woman. Patient concerns: A 26-year-old Iranian woman with a history of migraine and frequent use of acetaminophen and NSAIDs presented with persistent nausea, vomiting, and generalized abdominal pain lasting one week. Diagnoses: Prior outpatient endoscopy revealed a deep, clean-based gastric ulcer. Upon admission, physical examination showed signs of an acute abdomen. A computed tomography scan demonstrated intra-abdominal fluid, a cystic hepatic lesion, and a collection in the hepatogastric space, consistent with a perforated peptic ulcer and formation of a hepatogastric fistula. Interventions: The patient received supportive care, including fluid resuscitation, antibiotics, and proton pump inhibitor therapy. Surgical consultation was obtained, and management was directed toward treating the perforation and associated abscess formation. Outcomes: Following medical and surgical management, the patient’s condition stabilized, with resolution of abdominal symptoms and no recurrence during follow-up. Lessons: Fistula formation following PUD is an uncommon event, particularly involving the liver. This case emphasizes the importance of medical supervision in NSAID use and highlights that severe complications of PUD can develop even in young individuals. Awareness of such presentations can aid in timely diagnosis and management.