Images in Clinical Medicine

Cholecystoduodenal Fistula

Nina Singh, M.D., and Kevin Stempel, M.D.

N Engl J Med 1997; 336:266January 23, 1997

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Figure 1 A 69-year-old man with no prior biliary surgery had intermittent, self-limited episodes of fever and chills for three months and a cholestatic pattern of liver-enzyme elevations. A diagnosis of recurrent cholangitis due to cholelithiasis was made, and radiologic studies revealed a cholecystoduodenal fistula.

Nina Singh, M.D.
Kevin Stempel, M.D.
Veterans Affairs Medical Center, Pittsburgh, PA 15240