Choledochoduodenal fistula complicating chronic duodenal ulcer in Nigerians

Cholangitis Secondary to Food Material Impaction in the Common Bile Duct through a Choledochoduodenal Fistula

Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.

[Choledochoduodenal fistula of ulcer etiology]

INTRODUCTION

Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended.

CASE OUTLINE

The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now.

CONCLUSION

The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome.

Primary adenocarcinoma of the duodenum with choledochoduodenal fistula

BACKGROUND

Primary adenocarcinoma of the duodenum is an uncommon clinical entity. It has been associated with a dismal prognosis because it is rare and produces no distinctive symptoms until late in its course.

CASE SUMMARY

A 68-year-old man presented with a 6-month history of epigastralgia, anorexia, and progressive weight loss. Esophagogastroduodenoscopy showed a tumor mass in the deformed duodenal bulb with a fistula into the biliary tract. Upper gastrointestinal (UGI) barium studies and cholangiography confirmed a fistulous communication between the duodenum and biliary tree.

CONCLUSIONS

Aggressive evaluation of minor, yet refractory, UGI symptoms and a high index of suspicion offer the best hope for early diagnosis. Esophagogastroduodenoscopy and barium UGI study are the principal methods of diagnosis of these tumors. Early diagnosis would thus prevent metastasis and complications.

Spontaneous choledochoduodenal fistula complicating peptic ulcer disease--a case report

Spontaneous choledochoduodenal fistula is a rare complication of peptic ulcer disease, the surgical therapy of which is generally directed towards the ulcer disease itself, in the form of vagotomy with antrectomy or gastrojejunostomy. The case reported herein is of a 40 year old man who presented with a spontaneous choledochoduodenal fistula which was successfully treated by a truncal vagotomy and posterior retrocolic gastrojejunostomy. Such procedures as cholecystectomy, common bile duct exploration and bilio-enteric reconstruction, should only be performed in the case of a biliary stricture, which occurs rarely.

Parapapillary choledochoduodenal fistula: an analysis of 83 consecutive patients diagnosed at ERCP

Eighty-three patients with parapapillary choledochoduodenal fistula diagnosed at endoscopic retrograde cholangiopancreatography over a 10-year period were reviewed. Three cases were associated with carcinoma of the papilla; the remaining 80 (37 female, 43 male) had gallstones. Thirty-one patients had choledocholithiasis, 12 had gallbladder stones, and 14 had intrahepatic stones. Fifty-five patients (69%) had a history of jaundice, whereas 23 (29%) had never experienced jaundice.