Choledochoduodenal Fistula Secondary to Peptic Ulcer Disease: A Case Report

Abstract

Patient: Female, 29 Final Diagnosis: Choledocho-duodenal fistula Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: Gastro-jejunostomy • hepatico-jejunostomy Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Choledochoduodenal fistula is an uncommon complication secondary to peptic ulcer disease. Determining this diagnosis is challenging especially when confronted with unspecific physical and radiological findings. Case Report: Here we report a case of a 29-year-old Ethiopian female who presented to Geitaoui University Hospital in Beirut, Lebanon with epigastric pain and was diagnosed to have of choledochoduodenal fistula. Conclusions: Choledochoduodenal fistula is a rare complication of duodenal ulcer and this case report may help clinicians to identify suspected cases of this entity with similar presentations.

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

“…Several therapies have been proposed to treat entero-biliary fistula but no guidelines have been established yet ( 6 , 8 ). It is recommended to treat cholecysto-duodenal fistula surgically with cholecystectomy and closure of the fistula tract ( 40 – 42 ).…”

“…According to several authors, a surgical approach should be advised in case of failed medical treatment, gastric outlet obstruction, haemorrhage, perforation, recurrent gallstone ileus or recurrent cholangitis ( 5 , 8 , 32 , 43 ). For CDF due to PUD refractory to medical treatment, a vagotomy with an antrectomy and a reconstruction according to Billroth II procedure with a gastrojejunostomy can be performed ( 7 , 32 , 33 , 39 ).…”

“…It is a rare condition which can also result from PUD, tumours or Crohn disease involving the duodenum (4,6). Different types of fistulas can be encountered, the most common being the cholecysto-duodenal fistula (68%-90%) (4,(7)(8)(9). There is also the cholecysto-colonic fistula (10%-13.6%), the choledochoduodenal fistula (8.6%), the cholecysto-gastric fistula and the duodeno-left hepatic fistula, the last two being the rarest (4,(7)(8)(9).…”

A Case of Choledocholithiasis Complicated by Choledochoduodenal Fistula

“…The anatomical structure of the common bile duct features two physiological strictures: one occurs at the junction where the common bile duct enters the duodenum, and the other is at the duodenal papilla. Repeated stimulation of oppression and chronic inflammatory reactions, or long-term oppression of adjacent organ tumors, can cause damage to the bile duct wall, forming a fistula [1] . Another study reported that the common cause of CDF is duodenal ulcer, and the inflammatory reaction of larger ulcers is more severe, causing it to penetrate the duodenal wall and form a fistula with the rear common bile duct [2] .…”

Duodenal-Distal Ileal Fistula After Laparoscopic Radical Right Hemicolectomy: A Case Report

“…Enteroenteric fistulae often secondary to benign or malignant disease, such as colon cancer ( 1 ), Crohn's disease ( 2 ), radiation enteritis ( 3 ), peptic ulcer disease ( 4 , 5 ), and acute bowel ischemia ( 6 ), but duodenal fistulae are relatively rare. Additionally, among duodenal fistulae, internal duodenocolic fistulaes are relatively common, but duodeno-ileum fistulaes are rare.…”