Early management of acute upper gastrointestinal hemorrhage.
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A unique case of hematemesis is presented. The cause of upper gastrointestinal bleeding was a pyloroduodenal ulcer caused by erosion of a 5-cm gallstone impacted in the duodenal bulb. On review of the world literature of Bouveret's syndrome, this is the first case in which a preoperative diagnosis was well established and the fourth such case in which a successful surgical outcome was obtained.
Two cases of gastrointestinal bleeding due to aortic aneurysm with fistula to the duodenum are reported. When upper gastrointestinal fiberendoscopy rules out the commonest sources of bleeding but reveals no specific lesion, sonography is advisable. Accurate diagnosis and timely treatment are prerequisites for a successful outcome in this otherwise fatal condition.
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