Choledocoduodenal fistula

Gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal, cholecystogastric or rarely choledocoduodenal fistula is called as Bouveret's syndrome and it accounts for approximately 1-3% of all the patients with gallstone ileus. Although treatment modalities, including stone removal or fragmentation with classical endoscopic devices, such as snares, and forceps or fragmentation of gallstones with new devices, such as electrohydraulic lithotripsy, laser, extracorporeal shockwave lithotripsy have been described...

A biliary enteric fistula (BEF) is a rare, abnormal communication between any segment of the biliary tree with any portion of the small or large intestine. BEF is more frequently diagnosed with the increasingly widespread use of endoscopic retrograde cholangiopancreatography. Different theories have been postulated regarding the etiology of this fistula formation, with the most likely cause being gallstones. Treatment modalities, ranging from conservative management to surgical reconstruction, show varying levels of success...

A case of spontaneous choledocoduodenal fistula due to penetrating posterior duodenal ulcer is reported. The only presenting symptoms were pain and vomiting. There was no fever or recurrent jaundice which is usually expected in such a condition. The radiological findings included barium and air in the biliary tract. Biliary fistula are not uncommon. Although external biliary fistulae are seldom seen in present times, internal biliary fistulae are not a rare entity. Internal biliary fistulae are either spontaneous or due to operations on biliary tract...

A total of 21 cases are presented, of patients in whom Oddian sphincteroplasty was performed, according to an original technique. In 19 cases the indication was due to Oddian stenosis associated to lithiasis or hepatic hydatic cysts which had ruptured in the biliary pathways. In two other cases security sphincteroplasty of the Oddi sphincter was performed for lithiasis of the choledocus. The decision was based on macroscopic changes of the biliary pathways, on the control of the main biliary pathway. Sphincteroplasty was achieved with the aid of an original probe, and the incision of the ampullary area was in the average 25 mm in length...

The authors present 5 observations of choledocoduodenal fistula complicating chronic duodenal ulcer disease. Four cases were observed in Central Africa, the other in France. After a study of the frequency, and especially of the higher incidence in Africa, the authors review the problems associated with the pathology, clinical and diagnostic aspects of this complication. Moreover, they evoke the essential problems of management, as based on their experience and a review of the literature: medical vs. surgical treatment, should and how they treat the biliary lesions...

A new case of choledocoduodenal fistula secondary to duodenal ulcer is reported, which manifested as an ulcer complicated by haemorrhage, duodenal stenosis and cholangitis. We recommend endoendoscopy as the main diagnostic tool. Surgical treatment should consist of avoidance of the fistulous tract, cholecystectomy, cholangiography, truncal vagotomy and gastroduodenal drainage by pyloroplasty or gastroduodenostomy.