PMC5741137_01
Endoscopy demonstrating a subepithelial mass with overlying ulceration and an adherent clot in the duodenal bulb.
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F1
Upper endoscopy demonstrated a subepithelial mass with an overlying ulceration and an adherent clot in the duodenal bulb, with no histological evidence of a malignancy (Figure 1).
Computed tomography of the subepithelial duodenal mass (vertical arrows) showing air in the gallbladder (horizontal arrow).
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F2
Computed tomography (CT) obtained during the initial hospitalization demonstrated air within an inflamed gallbladder that contained stones and sludge, as well as a rounded, well-circumscribed mass in the duodenum (Figure 2).
Endoscopy demonstrating a mass-like lesion with a small orifice draining bile and small stones.
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F3
During suction to appose the lesion against the tip of the echoendoscope, the mass decompressed, and the areas of ulceration morphed into 2 small orifices draining bile and small stones (Video 1; Figure 3).
(A) Magnetic resonance imaging demonstrating the resolution of the mass-like density in the duodenum (arrows) and (B) the presence of choledocholithiasis along with the cholecystoenteric fistula.
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F4
Subsequent magnetic resonance imaging demonstrated resolution of the mass-like density in the duodenum (Figure 4). A small bile duct stone and subtle contrast opacification of the cholecystoduodenal fistula was also identified (Figure 4).
Follow-up endoscopy demonstrating decompression of the lesion with persistence of the fistula orifice.
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F5
Subsequent endoscopy to assess healing demonstrated the persistence of the fistula orifice and clear decompression of the mass lesion (Figure 5).