상부위장관 출혈을 동반한 담낭-위-대장 누공

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.