Abstract

A 66-year-old female patient had three operations performed in other hospitals, namely cholecystectomy, left lateral segmentectomy, and left medial segmentectomy of liver. She was then admitted for severe refractory duodenal ulcer and little discharge from the previous drainage wound. During the operation, localized perforation of duodenal ulcer and choduodenal fistula were found, so Billroth II gastrectomy and T-tube drainage were performed. She was then left with bile leakage from penrose drain whenever the T-tube was clamped. Endoscopic retrograde cholangiopancreatography (ERCP) revealed choledochoduodenocutaneous fistula. Nothing by mouth, total parenteral nutrition (TPN), biliary stent, endoscopic nasobiliary drainage catheter in afferent loop (A loop), and somatostatin infusion were given, and finally the biliary cutaneous fistula healed with the removal of T-tube and penrose drain.

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