A STUDY OF ELEVEN CASES OF SPONTANEOUS DUODENAL FISTULA

Abstract

Eleven patients with spontaneous duodenal fistula were subjected to a study of diangosis and surgical treatment. The 11 patients included 9 with cholecystoduodenal fistula and 2 with coloduodenal fistula. Preoperative diagnosis could be made in 7 (64%) out of the 11 based on pneumobilia in abdominal scout X-P and GI series. Direct cholangiography, which was performed in only a few cases, could yield the definite diagnosis with a high rate. The patients basically underwent surgical treatment for original disease and excision of fistula. In 9 patients the duodenal intestine was directly sutured after excision of fistula, where the depression treatment due to T tube to the billiary tract added to all the patients were very effective without anastomotic leakage. For 2 of 3 patients with gallstone ileus who manifested poor condition preoperatively, incision of small intestine and cholelithotomy were done, but the fistulae were left. From these findings, it seems important to add some depression treatment to the billiary tract after excision of fistula. Moreover, in a case of gallstone ileus which have no residual stones, excision of fistula accompanied by inevitable large operative invasion is not always necessary.