Abstract
Peptic ulcer complication has decreased over le last years. Spontaneous bilio-digestive fistulas, in the absence of primary biliary disease, remain a very unusual complication of the upper digestive tract. The choledochoduodenal fistula is an extremely rare entity which can be caused by a duodenal peptic ulcer. It appears with the symptoms of peptic ulcer disease. They are diagnosed incidentally on radiological exams. It was suspected after finding pneumobilia on abdominal ultrasound and confirmed by X-barium meals study. The purpose of this observation is to report the case of a patient presenting a choledochoduodenal fistula diagnosed by X-barium meal to underline the importance of this radiological exam to diagnose this disease and to insist on the conservative treatment for choledochoduodenal fistula caused by a duodenal peptic ulcer. The prognosis of patients treated medically is good, although the fistula can remain asymptomatic. Angiocholitis and biliary sequelae remain rare and do not warrant prophylactic surgical treatment.
Highlights
Internal and spontaneous bilio-digestive fistulas, in the absence of primary biliary disease, remain a very unusual complication of the upper digestive tract
A choledochoduodenal fistula (CDF) is an extremely rare entity which can be caused by a duodenal peptic ulcer
Most choledochoduodenal fistulas are diagnosed incidentally by hepato-biliary radiological and endoscopic investigations. The purpose of this observation is to report the case of a patient presenting a CDF diagnosed by X-barium meal to underline the importance of this radiological exam to diagnose this disease and the performance of conservative treatment for CDF caused by a peptic duodenal ulcer
Summary
Internal and spontaneous bilio-digestive fistulas, in the absence of primary biliary disease, remain a very unusual complication of the upper digestive tract. Most choledochoduodenal fistulas are diagnosed incidentally by hepato-biliary radiological and endoscopic investigations The purpose of this observation is to report the case of a patient presenting a CDF diagnosed by X-barium meal to underline the importance of this radiological exam to diagnose this disease and the performance of conservative treatment for CDF caused by a peptic duodenal ulcer. A 59-year-old man suffering for 9 months of epigastric pain, retrosternal burns and vomiting This symptomatology is relieved by proton pump inhibitors. An oesogastroduodenal endoscopy performed after two months of medical treatment confirm the disappearance of the duodenal ulcer and the choledochoduodenal fistula.
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