Choledochoduodenal Fistula Secondary to Ulcer Disease Presenting With Gastrointestinal Bleeding

An 84-year-old woman presented with hematemesis and epigastric pain. Her medical history was notable for a cerebrovascular accident, and she was taking aspirin and nonsteroidal anti-inflammatory drugs. Her serum hemoglobin level decreased to 6.7 g/dL (range, 11–17 g/dL), and her blood urea nitrogen level increased to 107 mg/dL (range, 17–43 mg/dL). An esophagogastroduodenoscopy (EGD) was performed, which showed a large duodenal ulcer (DU) with an adherent clot and an orifice suggestive of perforation (Figure A).

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