A 65-year-old female with a history of chronic gastritis presented with repeat epigastric pain and heartburn after meals. A physical examination was unremarkable, other than a mild fever and epigastric tenderness. Laboratory data revealed leucocytosis of 11,340/μl with 86.8 % of neutrophils, elevated γ-glutamyltransferase at 282.1 IU/l and mildly abnormal AST 40.5 IU/l, ALT 74.9 IU/l, total bilirubin 30.4 μmol/l (direct bilirubin 9.4 μmol/l) and amylase 202 IU/l. A gastroscopy showed a 4 mm fistula on the anterior wall of the proximal duodenal bulb, without ulcerations and the patient was admitted for intravenous antibiotic therapy.
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| http://dx.doi.org/10.17235/reed.2020.7074/2020 | DOI Listing |
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