A 50-year-old man was admitted to our hospital because of a single episode of hematemesis followed by melena for about 14 hours. On gastroendoscopy a 1.2 x 1.4 cm2 deep ulcer was visualized in the back wall of the first part of the duodenum with active bleeding. Digital subtracted angiography showed an obvious leakage of contrast agents from the gallbladder artery. So hemobilia and cholecystoduodenal fistula with upper gastric tract bleeding were diagnosed. Cholecystectomy was performed after the duodenal fistula was resected and repaired. Common bile duct was intubated with a T-tube after no bleeding and stones were verified inside. A pathologic examination confirmed the presence of chronic cholecystitis with the formation of suppurate granulomatosis. The postoperative course was uneventful. He has been doing well without any recurrence of bleeding for the last 7 months.
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