Online Images in the Medical Sciences|Articles in Press

Gastric volvulus associated with bronchobiliary fistula

Published:February 14, 2023DOI:
      A 67-year-old woman presented to hepatobiliary surgery department with a 3-month history of epigastric pain and loss of appetite, accompanied by paroxysmal cough and coughing up bile-like substance in the past week. She had a history of multiple operations for cholelithiasis. Laboratory evaluation revealed the following: white blood cell count, 10.4 × 109/L (reference range, 3.5-9.5 × 109/L); C-reactive protein, 65.28 mg/L (reference range, 0.0-8.0 mg/L); total bilirubin, 35.6 μmol/L (reference range, 1.71-21 μmol/L); direct bilirubin, 13.6 μmol/L (reference range, 0-7.32 μmol/L); indirect bilirubin, 22.0 μmol/L (reference range, 0-13.68 μmol/L); alkaline phosphatase, 334.7 U/L (reference range, 45-135 U/L). Upper gastrointestinal radiography (Figure 1A) showed rotation of the stomach along its long axis with reversal of the greater and lesser curvatures (red arrow), and right subphrenic nodular calcification (yellow arrow). Abdominal MR (Figure 1B and C) revealed gastric volvulus (red arrow), bile duct stone (yellow arrow), cholangiectasis with a fistulous towards thoracic cavity (green arrow). A laparoscopic approach revealed adhesion of the greater curvature to right upper abdomen, and the presence of a fistulous between bile duct and thoracic cavity after lithotomy. The fistula was sutured and the diaphragmatic defect was repaired. However, severe septic shock occured after operation and she was discharged 20 days after anti-infectious therapy. The patient was feeling well at 1 month of follow-up.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Khan AA
        • Khan AU
        • Kupec JT
        Organoaxial gastric volvulus.
        Clin Gastroenterol Hepatol. 2021; 19: A26
        • Acquasanta M
        • Spadarella G
        • Civelli EM
        Spontaneous bronchobiliary fistula: case report.
        J Radiol Case Rep. 2020; 14: 10-15