{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:34:26Z","timestamp":1776818066477,"version":"3.51.2"},"reference-count":14,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/501100000762","name":"Imperial College Healthcare NHS Trust","doi-asserted-by":"publisher","award":["949113"],"award-info":[{"award-number":["949113"]}],"id":[{"id":"10.13039\/501100000762","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,17]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>A 75-year-old man presented with a 3-week history of melaena and right upper quadrant pain. This was on a background of significant alcohol intake and a complex medical history. He was haemodynamically unstable with investigations indicating a new iron-deficiency anaemia. After resuscitation, urgent intervention was required under general anaesthesia. This involved a triple phase abdominal CT, followed by emergency oesophagogastroduodenoscopy. This revealed deep ulceration with extension to the pancreatic head and common bile duct. There was also evidence of pneumobilia on CT, secondary to a choledochoduodenal fistula. Treatment encompassed an invasive and medical approach. 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