Choledochoduodenal fistula in the setting of Crohn’s disease

Abstract

Of all the spontaneous fistulas that occur between the extrahepatic biliary system and the intestine, a choledochoduodenal fistula is rarely seen. When it does occur, it is most often secondary to a perforated duodenal ulcer, choledocholithiasis, or cholelithiasis. It may also be seen following complications related to iatrogenic injury or tuberculosis. Generally, choledochoduodenal fistulas are asymptomatic, but may present with vague abdominal pain, fever, and other symptoms related to cholangitis. As a result, they can be difficult to diagnose clinically before imaging is obtained. We present a case of a 74 year old, asymptomatic, female with a past medical history significant for Crohn's disease who was found to have a choledochoduodenal fistula demonstrated on MRCP, possibly secondary to her underlying inflammatory bowel disease.

A Rare Presentation of Choledochoduodenal Fistula Due to Ovarian Cancer Metastasis

“…1 They are caused by gallstones (90%), peptic ulcer disease (6%), and malignancy or trauma (4%). 1,2 Patients with CDF lose the barrier of papilla so there is an exposure of the biliary system to gut flora and also chronic fluid and electrolyte wasting in the biliary system and malabsorption mimicking the symptoms of cholelithiasis. 3 It can also present as pneumobilia, the air in the biliary tree.…”

An Unusual Case of Choledochoduodenal Fistula Secondary to Peptic Ulcer Presenting With Cholangitis and Pneumobilia

“…Choledochodoudenal fistula (CDF) in PUD is a rare complication that occurs as a result of a duodenal ulcer penetrating the common bile duct (CBD) [2]. The other possible etiologies of CDF are biliary lithiasis, tumor, Crohn's disease, tuberculosis, and iatrogenic injury [3][4][5]. However, sometimes, there may be no obvious cause of this disorder.…”