A portal fistula in a patient with large common bile duct stones - the cause of fatal bleeding during endoscopic transpapillary intervention

The aim: To describe a rare case of a bilioportal fistula in a patient with large multiple common bile duct (CBD) stones complicated by massive intraoperative bleeding. Clinical case: A 40-year-old female patient with clinical and instrumental signs of multiple large CBD stones, moderate mechanical jaundice and signs of anemia of unclear genesis was hospitalized for endoscopic retrograde transpapillary intervention. At the stage of performing endoscopic mechanical lithotripsy, profuse bleeding from the CBD occurred, which did not respond to endoscopic hemostasis. Performed laparotomy, duodeno- and choledochotomy also did not allow to detect the source of bleeding. After preventive stitching of the endoscopic papillotomy area, drainage of the CBD, the patient was transferred to the intensive care unit, where she died due to decompensation of cardiovascular activity. At the autopsy, a bilioportal fistula was found, which was formed as a result of bedsore by a biliary stone of the wall of the CBD and portal vein, which served as a source of massive fatal bleeding. Conclusion: The described complication is casuistic, however, awareness of it, precision collection of anamnesis, timely diagnosis and treatment of gallstone disease can help to avoid a fatal outcome in the future.