Spontaneous Choledochoduodenal Fistula Research Articles

Choledochoduodenal fistula: A rare cause of upper gastrointestinal bleeding in a child

Spontaneous choledochoduodenal fistula (CDF) is a rare form of biliary enteric fistula. A child with CDF who had a motor vehicle collision as a pedestrian at the age of 2 years is presented in this article. Since the accident, recurrent abdominal pain and black-colored stools were noted thrice a year. As a 13- year-old, the patient was admitted with vomiting of blood and melena. He was hospitalized with gastrointestinal bleeding. Endoscopy is performed because of bleeding and a fistula was detected incidentally. Barium swallow series and magnetic resonance cholangiopancreatography showed a fistula tract. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the definitive diagnosis and guided treatment. In our case, we emphasize the importance of ERCP in facilitating the diagnosis of CDF. Barium swallow radiography detects the passage of barium to the biliary system in only half of the CDF patients diagnosed via ERCP. In summary, we reported the youngest case of CDF with a large fistula orifice managed by endoscopic sphincterotomy.

Secondary sclerosing cholangitis from percutaneous transhepatic biliary drainage in a patient with gallbladder cancer after surgery: A case report

Secondary sclerosing cholangitis (SSC) is a chronic cholestatic liver disease characterized by fibrosis and stricture of the bile ducts. SSC in association with multiple factors such as spontaneous choledochoduodenal fistula and metastatic gallbladder cancer has rarely been reported. However, to the best of our knowledge, reports of SSC after percutaneous transhepatic biliary drainage (PTBD), especially in cases with diffuse calcification of the bile duct walls, have not been reported. We report a case of SSC from PTBD in a patient with gallbladder cancer after surgery. The patient underwent external percutaneous biliary drainage for malignant bile duct obstruction after cholecystectomy. Repeated exchanges were performed at the first and the sixth month after PTBD using an internal and external drainage catheter. Two months after the third catheter exchange, findings of laboratory and imaging examinations were suggestive of SSC. The liver function tests of the patient were suggestive of cholestasis. Multidetector computed tomography showed diffuse calcification of the bile duct walls. Cholangiography showed intrahepatic biliary stenosis or dilatation.

Importance of Spontaneous Choledochoduodenal Fistulas Detected During ERCP Procedure.

Choledochoduodenal fistula (CDF) is an abnormal passage between the choledochus and duodenum. The most common causes of CDF are cholelithiasis, duodenal ulcer, and tumors. There are mainly two types of fistulas depending on the location. Type 1 is usually present on the longitudinal fold just close to the papilla. Type 2 is present at the duodenal mucosa adjacent to the longitudinal fold and probably caused by larger stones, duodenal ulcer penetration, impacted cystic duct stones, and as a complication of laparoscopic cholecystectomy. In this study, we investigate the characteristics of our patients those were diagnosed with CDF. This is a descriptive study. We retrospectively obtained the data of 21 patients with spontaneous CDF out of 2430 endoscopic retrograde cholangiopancreaticography (ERCP) patients between 2000 and 2014. We analyzed the laboratory results, demographic and etiological features, major clinical presentations, diagnostic methods, and treatment modalities of the patients. The mean age of the 21 patients was 66.6±2.2years and a female to male ratio was 12:9. In ten patients, interventional procedures were performed via fistulotomy, not through the papilla. The eventual diagnosis was tumor in five patients and stone or sludge in bile ducts in 14 patients. In the remaining two patients, no reason was found as a cause of CDF. Whipple operation was performed in one patient and stents were placed in three patients for malignacy. Among the 14 patients with sludge or stone in bile ducts, ERCP has been therapeutic in ten. One of the remaining patients has been operated for proximal fistula and underwent choledochus exploration and repair of fistula over a T-tube. In the second patient, stone extraction and T-tube drainage were performed. In patients who had bile duct obstruction and got over of jaundice afterwards, one of the most important reasons of this recovery is the development of spontaneous choledochoduodenal fistula. Even if it is very rare, malignancy can be observed in this area. Therefore, it is extremely important to evaluate the papillary area with ERCP and to conduct biopsy; this will make early diagnosis possible in many patients. In these patients, ERCP can both be diagnostic and therapeutic.

Obstructed Common Bile Duct Stent Leading to a Spontaneous Choledocho-duodenal Fistula: A Rare Complication

Obstructed Common Bile Duct Stent Leading to a Spontaneous Choledocho-duodenal Fistula: A Rare Complication

Late Migration of Covered Metal Stent to the Stomach Through a Spontaneous Choledochoduodenal Fistula in a Patient With Malignant Biliary Obstruction

We report a case in which a spontaneous choledochoduodenal fistula occurred after biliary covered self-expanding metal stent (SEMS) placement and a late transfistula migration of the stent in a patient with malignant distal biliary obstruction. A partially covered WallFlex biliary stent (Boston Scientific) was appropriately implanted in the common bile duct. Subsequently the patient received chemotherapy with gemcitabine. After 7 months of the SEMS insertion, the patient presented with frequent vomiting. Abdominal computed tomography revealed the obstruction of the duodenal descending part and the migrated stent in the stomach. A choledochoduodenal fistula was observed endoscopically at the proximal point of the duodenal obstruction. These findings can cleanly account for the SEMS migration through the fistula. The mechanism of formation of the fistula is mostly associated with a mechanical contact between the bile duct wall and the SEMS edge, which is pushed up in the direction of the duodenum because of the enlargement of the primary tumor, finally penetrating through the duodenal wall. To our knowledge, this is an extreme unusual case, which has been unreported previously. Therefore, we emphasize the necessity of being alert to the potential for such complications in cases involving placement of SEMS for malignant biliary obstruction.

Spontaneous Choledochoduodenal Fistula after Metallic Biliary Stent Placement in a Patient with Ampulla of Vater Carcinoma

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.

ERCP and pyogenic liver abscess

Background: Liver abscess is commonly biliary in origin. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in patients with pyogenic liver abscesses. Methods: Between January 1986 and December 1997, 63 patients with pyogenic liver abscesses were referred for ERCP. Twenty-one patients had a history of previous biliary procedures including cholecystectomy (21), biliary-enteric bypass (9), surgical sphincteroplasty (5), and endoscopic sphincterotomy (2). Demographic data, clinical features, biochemical parameters, treatment, clinical progress, and follow-up were recorded and analyzed. Results: Two patients required laparotomy and 61 patients underwent guided aspiration and/or drainage at a median interval of 3 days after presentation. ERCP was performed at a median of 8 days (range 1 to 69 days) after initial treatment and succeeded in 90% of cases with no associated complication or death. Abnormalities were shown in 29 (46%) patients: biliary obstruction due to stones or strictures (15), ductal dilatation alone (7), spontaneous choledochoduodenal fistula (3), communication between abscesses and biliary tree (3), and splaying of biliary ducts by space-occupying effect (2). No abnormality was found in 34 patients. Eight patients underwent endoscopic therapy including sphincterotomy (5), stone extraction (6), and nasobiliary drainage (2). Overall mortality rate from liver abscesses was 6%. Conclusions: ERCP is useful in the treatment of patients with pyogenic liver abscesses. (Gastrointest Endosc 1999;50:340-4.)

Spontaneous Choledochoduodenal Fistula due to Peptic Ulcer Disease

Spontaneous choledochoduodenal fistula is a rare complication of peptic ulcer disease, and surgical is generally directed towards the ulcer itself. We present 2 cases with spontaneous choledochoduodenal fistula due to peptic ulcer disease. One of our cases is a 27-year-old male who had a 3-year history of duodenal ulcer, while the other patient is a 56-year-old female who had a 5-year history of peptic ulcer and developed pyloric stenosis in the last month before hospitalization. Both these patients were successfully treated by truncal vagotomy with antecolic gastrojejunostomy. They were asymptomatic for follow-up periods of 8 months and 6 years, respectively.

Ulcerogenic choledochoduodenal fistula

Spontaneous choledochoduodenal fistula is a rare form of biliary enteric fistula which is usually related to peptic ulcer disease and therefore is seen more often in men. This is in contrast to the more common cholecystoduodenal fistula which is associated with calculous gall-bladder disease and occurs predominantly in women. We report two cases diagnosed by radiology following unhelpful laparotomy.