Reviewer's report 
 Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the Title: 
literature 
 2  26 October 2006 Version: Date: 
 Muhammed Ashraf Memon Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Under the case report you have made the following statements: 
1. UGIE: Second part of duodenum was normal with bile (no blood) 2. 3X3 cm pseudo-aneurysm which had ruptured into the 1st part of the duodenum 3. Proximal CBD was dilated and on exploration clots were removed 
Under discussion: 
There was no bleeding from the papilla 
The problem is that: 
1. How did the clot appeared in the CBD when the pseudoanursym of the cystic duct eroded into the first part of the duodenum and not in the bile duct 
2. Secondly you have clearly stated above that the second part of the duodenum had not clots and that 
there was no bleeding from the papilla. In other words you are contradicting yourself because if there were clots in the CBD there must be some source of bleeding and therefore you would have seen some bleeding from the papilla and some clots in the 2nd part of the duodenum. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Introduction: 
Line 6: Remove very before rare 
Line 7: Add reference "Memon MA, Hassan K, Shennan JM. Post Bulbar Chronic duodenal ulcer with major 
upper GIT bleeding from cystic artery. Postgraduate Medical Journal 1995; 71(832): 125-126." 
Case Report: 
Paragraph 1, Line 5: 7days, substitute it for 7 days 
Paragraph 1, Line 6: "tacchycardia (pulse 110/min)", substitute it for tachycardia of 110/min 
Paragraph 2, Line 2: (normal 10-15 mg%) should be (10-15 gm/dl). 
Paragraph 2: Remove the word "normal" from all the values in brackets as it is understood that those values 
represents the normal reference range. 
Paragraph 3, Line 2: started on proton pump inhibitors: What route? oral or IV 
Paragraph 4, Line 1: to confirm gallstones add , after gallstones 
Paragraph 4, Line 23: "She" should be substituted for The patient 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Reviewer's report 
 Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the Title: 
literature 
 2  26 October 2006 Version: Date: 
 Muhammed Ashraf Memon Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Under the case report you have made the following statements: 
1. UGIE: Second part of duodenum was normal with bile (no blood) 2. 3X3 cm pseudo-aneurysm which had ruptured into the 1st part of the duodenum 3. Proximal CBD was dilated and on exploration clots were removed 
Under discussion: 
There was no bleeding from the papilla 
The problem is that: 
1. How did the clot appeared in the CBD when the pseudoanursym of the cystic duct eroded into the first part of the duodenum and not in the bile duct 
2. Secondly you have clearly stated above that the second part of the duodenum had not clots and that 
there was no bleeding from the papilla. In other words you are contradicting yourself because if there were clots in the CBD there must be some source of bleeding and therefore you would have seen some bleeding from the papilla and some clots in the 2nd part of the duodenum. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Introduction: 
Line 6: Remove very before rare 
Line 7: Add reference "Memon MA, Hassan K, Shennan JM. Post Bulbar Chronic duodenal ulcer with major 
upper GIT bleeding from cystic artery. Postgraduate Medical Journal 1995; 71(832): 125-126." 
Case Report: 
Paragraph 1, Line 5: 7days, substitute it for 7 days 
Paragraph 1, Line 6: "tacchycardia (pulse 110/min)", substitute it for tachycardia of 110/min 
Paragraph 2, Line 2: (normal 10-15 mg%) should be (10-15 gm/dl). 
Paragraph 2: Remove the word "normal" from all the values in brackets as it is understood that those values 
represents the normal reference range. 
Paragraph 3, Line 2: started on proton pump inhibitors: What route? oral or IV 
Paragraph 4, Line 1: to confirm gallstones add , after gallstones 
Paragraph 4, Line 23: "She" should be substituted for The patient 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Please review this paper.
user
Reviewer's report 
 Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the Title: 
literature 
 2  26 October 2006 Version: Date: 
 Muhammed Ashraf Memon Reviewer: 
Reviewer's report: 
General 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be reached) 
Under the case report you have made the following statements: 
1. UGIE: Second part of duodenum was normal with bile (no blood) 2. 3X3 cm pseudo-aneurysm which had ruptured into the 1st part of the duodenum 3. Proximal CBD was dilated and on exploration clots were removed 
Under discussion: 
There was no bleeding from the papilla 
The problem is that: 
1. How did the clot appeared in the CBD when the pseudoanursym of the cystic duct eroded into the first part of the duodenum and not in the bile duct 
2. Secondly you have clearly stated above that the second part of the duodenum had not clots and that 
there was no bleeding from the papilla. In other words you are contradicting yourself because if there were clots in the CBD there must be some source of bleeding and therefore you would have seen some bleeding from the papilla and some clots in the 2nd part of the duodenum. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Introduction: 
Line 6: Remove very before rare 
Line 7: Add reference "Memon MA, Hassan K, Shennan JM. Post Bulbar Chronic duodenal ulcer with major 
upper GIT bleeding from cystic artery. Postgraduate Medical Journal 1995; 71(832): 125-126." 
Case Report: 
Paragraph 1, Line 5: 7days, substitute it for 7 days 
Paragraph 1, Line 6: "tacchycardia (pulse 110/min)", substitute it for tachycardia of 110/min 
Paragraph 2, Line 2: (normal 10-15 mg%) should be (10-15 gm/dl). 
Paragraph 2: Remove the word "normal" from all the values in brackets as it is understood that those values 
represents the normal reference range. 
Paragraph 3, Line 2: started on proton pump inhibitors: What route? oral or IV 
Paragraph 4, Line 1: to confirm gallstones add , after gallstones 
Paragraph 4, Line 23: "She" should be substituted for The patient 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
assistant