Choledochoduodenal Fistula Secondary to Duodenal Ulcer

Wagner, G. R.; Passaro, Edward

doi:10.1001/archsurg.1971.01350070047010

Cited by 13 publications

(5 citation statements)

References 9 publications

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“…The first and second parts of the duodenum are crossed by the common bile duct posteriorly after which it is separated from the duodenum by pancreatic tissue before ending at the Ampulla of Vater. Choledochoduodenal fistulae occur most frequently in conjunction with posterior duodenal ulcers [3,6] though they have also been reported to occur with anterior duodenal ulcers [7].…”

Section: Introductionmentioning

confidence: 99%

Duodenal ulcer with choledochoduodenal fistula presenting acutely with free perforation into the peritoneal cavity

2008

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Section: Introductionmentioning

confidence: 99%

Duodenal ulcer with choledochoduodenal fistula presenting acutely with free perforation into the peritoneal cavity

2008

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“…It is a known complication of many diseases, including common bile duct stones (CBDS), duodenal ulcers, periampullary tumours, papillitis and pancreatitis 1,2 . In the West, posterior penetrating duodenal ulcer is the most common cause of CDF (80%) 3,4 . In the past decade, because of the advancement of potent anti‐ulcer drugs, the incidence of CDF induced by duodenal ulcers is diminishing.…”

Section: Introductionmentioning

confidence: 99%

New Strategy to Prevent Ascending Cholangitis in Larger Choledochoduodenal Fistula

Ding

Yongqian

et al. 2006

ANZ Journal of Surgery

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“…Jaundice or cholangitis is a rare complication of duodenal ulcer-related CDF. 3,4 Most CDFs are discovered incidentally during a plain abdominal radiograph or an upper gastrointestinal barium series. Endoscopy has been used infrequently for visualization and delineation of the fistulous communication.…”

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confidence: 99%

Choledochoduodenal Fistula: A Vanishing Complication of Peptic Ulcer Revisited

Laajam

Zargar²,

Al-Teimi³

et al. 1994

Annals of Saudi Medicine

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Spontaneous biliary-enteric fistula is a well recognized though uncommon disorder. Whereas cholecystoduodenal fistula accounts for 90% of biliary-enteric fistulas, the choledochoduodenal fistula (CDF) is a rarer type.1,2 The majority of the former fistulas are caused by cholelithiasis, whereas 80% of CDFs are due to duodenal ulcer. Jaundice or cholangitis is a rare complication of duodenal ulcer-related CDF.3,4 Most CDFs are discovered incidentally during a plain abdominal radiograph or an upper gastrointestinal barium series. Endoscopy has been used infrequently for visualization and delineation of the fistulous communication. 5,6The present reports describe two patients with duodenal ulcer that perforated into the common bile duct and subsequently was complicated by cholangitis in one patient. The role of endoscopy in the diagnosis of CDF is stressed. A review of the modern management of CDF is also outlined. Case Reports Case 1:A 44-year-old Indian nonsmoking male doctor with a 10-year history of proven recurrent duodenal ulcer was referred to us for the evaluation of biliary-enteric fistula. He has been on regular H 2 antagonist medication for the last five years. He suffered three episodes of cholangitis during the previous 14 months. The investigations during the second episode of cholangitis at another hospital led to the suggestion of biliary-enteric fistula based on gas in the biliary tree on the plain radiograph of the abdomen (Figure 1) and ultrasonography. The upper gastrointestinal endoscopy showed grossly deformed duodenal bulb with an active ulcer and narrowing. An attempt at endoscopic retrograde cholangiopancreatography (ERCP) failed because of the duodenal narrowing. Upper gastrointestinal (UGI) barium series was not performed at this stage. The patient was given anti-ulcer therapy. Four months later, while on treatment, he developed another episode of cholangitis and was referred to us for evaluation one month later.Physical examination was normal. Laboratory data showed elevated alkaline phosphatase 260 IU/L (normal <170 IU/L); serum amylase and gastrin levels were normal. The examination of UGI tract with pediatric fiberendoscope revealed grossly deformed duodenal bulb with narrowing and an active ulcer at the apex. An opening 2 mm in diameter was seen within the ulcer, through which bile and air were exuding, bathing the ulcer. The postbulbar area was entered with great difficulty and was normal. The opening was cannulated with a standard ERCP catheter and on injection of contrast, the common bile duct (CBD) was visualized along with the gallbladder (Figure 2). The duct was dilated to 12 mm with narrowing at its lower end and the gallbladder was normal. The CBD retained enough contrast one hour later to suggest delayed drainage (Figure 3). The ERCP was not possible to perform due to the degree of duodenal deformity and narrowing.Surgery was performed which included gastrojejunostomy, vagotomy and Roux-en-Y choledocho-jejunostomy. The findings included chronic penetrated duodenal ulcer with ...

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Choledochoduodenal Fistula Secondary to Duodenal Ulcer

Cited by 13 publications

References 9 publications

Duodenal ulcer with choledochoduodenal fistula presenting acutely with free perforation into the peritoneal cavity

Duodenal ulcer with choledochoduodenal fistula presenting acutely with free perforation into the peritoneal cavity

New Strategy to Prevent Ascending Cholangitis in Larger Choledochoduodenal Fistula

Choledochoduodenal Fistula: A Vanishing Complication of Peptic Ulcer Revisited

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