Choledochoduodenal fistula: An unusual cause of recurrent cholangitis in children

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. We present a case of BEF secondary to large common bile duct stones, successfully treated with endoscopic sphincterotomy (EST) followed by papillary balloon dilatation, and we briefly discuss large stone retrieval in the setting of atypical anatomy.

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“…As this condition is most commonly stone-induced, different treatment modalities are utilized depending on the severity of the disease. 8 …”

Section: Discussionmentioning

confidence: 99%

“…CDF most commonly presents with epigastric pain (80.9%), cholangitis (54.2%), and nausea or vomiting (10.3%). Jaundice is not a typical finding, especially with large stones due to fistula drainage 3,7,8…”

Section: Introductionmentioning

confidence: 99%

Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis

Shams

Cannon

Bortman

et al. 2018

ACG Case Reports Journal

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“…In patients with poorly controlled symptoms or associated complications, surgery is indicated. Distal CDF can be treated with endoscopic approaches, but proximal CDF cannot be endoscopically corrected and early surgery is indicated and effective treatment is biliary enteric anastomosis [10] .…”

Section: Discussionmentioning

confidence: 99%

Duodenal ulcer complicated with choledochoduodenal fistula and pneumobilia in a young child: A very rare case report

Wani¹,

Mufti²,

Bhat³

et al. 2015

J. Med. Res.

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Spontaneous pneumobilia is the disease of elderly, usually results from abnormal biliary-enteric communication mostly as a consequence of cholelithiasis related gall bladder perforation in to the normal duodenum. Pneumobilia due to choledochoduodenal fistula (CDF) from duodenal ulcer is quite rare nowadays due to the low prevalence of peptic ulcer disease and has not been reported in children. We reported a case of duodenal ulcer related CDF with pneumobilia in a young child. Medical management is effective in such cases and surgery is indicated in cases of poorly controlled symptoms or complications.

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“…In this case, the BEF appears to result from micropenetration of chronic peptic ulcers, reported to account for 5% of cases (2). Diagnosis is made by computed tomography for pneumobilia, contrast radiology or MRCP for localization, and ERCP allowing simultaneous treatment (3,4).…”

Section: Figurementioning

confidence: 99%

Biliary‐enteric Fistula, A Rare Complication of Peptic Ulcer Disease in Children

Peng¹,

Wei²,

Yeung

2018

J. pediatr. gastroenterol. nutr.

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A 14-year-old boy presented with abdominal pain and hematemesis, following two years of occasional vague epigastralgia. Radiographs showed no evidence of perforation; hepatobiliary ultrasound showed an inflamed gallbladder (GB) and a hypoechoic ill-defined mass shadow. CT revealed a distinct air bubble in the edematous GB, suspicious for a biliary-enteric fistula (BEF). Upper endoscopy showed cobblestone mucosa with ulcerations in the antrum and duodenum (Figure 1). Helicobacter pylori test was negative.Symptoms persisted despite proton-pump inhibitor. MRCP demonstrated a stretching appearance of the cystic duct, fluid accumulation in the GB fossa, and wall thickening and luminal narrowing in the preand post-pyloric region. Exploratory laparoscopy elucidated severe adhesions between the pylorus, duodenum and GB, but no fistula. The sonographic mass appeared to be localized fibrosis due to chronic

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Choledochoduodenal fistula: An unusual cause of recurrent cholangitis in children

Cited by 4 publications

References 7 publications

Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis

Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis

Duodenal ulcer complicated with choledochoduodenal fistula and pneumobilia in a young child: A very rare case report

Biliary‐enteric Fistula, A Rare Complication of Peptic Ulcer Disease in Children

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