We report the case of a 78-year-old woman with multiple antecedents including bronchial asthma, morbid obesity, obstructive sleep apnea syndrome, chronic renal failure with anemia and secondary hyperparathyroidism CTvulcis, bilateral atrial fibrillation and heart failure treated
She was admitted due to a 4-day history of hematochezia, with no fever, abdominal pain, or associated changes in intestinal rhythm, with a marked worsening of her habitual dyspnea.
Physical examination revealed diffuse analytical discomfort with creatinine deficiency in the right hypochondrium, and analytically showed anemia with Hb of 7.3 g/dl (N: 12-16), fibrinogen of 727 mg/dl and 148 mg/dl (N:
A fistulous layer was created in which a double-lumen image was observed at the hepatic angle of the colon, presenting in addition to the natural lumen of the colon a second light of smaller caliber, through which an aspect content emerged.
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Intimate fat mass was measured by abdominal CT, which showed an aerobilia, and a scleroatrophic gallbladder in contact with the hepatic angle of the colon, whose wall was thickened but without alteration of the underlying fat.
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It was decided to complete the study with an opaque enema in which we finally observed the presence of a fistulous tract at the hepatic angle of the colon, of a caliber approximately 6 mm, which seemed to communicate with the bile duct.
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The final diagnosis was chronic gastrointestinal angle with internal biliary fistula of the colon and secondary low bleeding.
During admission, the patient required transfusion of 4 units of concentrates, hemodynamically stable and afflicted, without diarrhea or new episodes of hematochezia.
Given the patient's underlying pluripathology and good evolution of the acute condition, conservative management was decided, ruling out surgical intervention and therapeutic ERCP.
She was discharged uneventfully.
He remained asymptomatic two months after discharge although he died a time later for cardiorespiratory disease.
