Duodenal tuberculosis with a choledocho‐duodenal fistula

Abstract

A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.

Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration

“…CDF is a relatively rare form of biliary-intestinal fistula and it contributes to 3.5–20% of all internal biliary fistulas. 2,4 Eighty per cent of these CDFs are secondary to penetrating duodenal ulcers 1 . Stones in the bile duct, echinococcal disease and, rarely, tumours of the stomach and pancreas are the other known causes of CDF 2 .…”

Pancreatic Tuberculosis with a Pancreaticobiliary Fistula

“…Fistulas, such as choledochoduodenal fistulas, develop in pancreatic TB [6][7][8], as in other TB diseases. Our patient had a pancreaticobiliary fistula, which has not been previously reported.…”

“…TB is associated with fistulas, including duodenocolic, enterocutaneous, and choledochoduodenal fistulas [6][7][8], which may be distinct findings in imaging modalities. Recently, we experienced a patient with pancreatic TB presenting with a pancreaticobiliary fistula.…”

Choledochoduodenal fistula in the setting of Crohn’s disease

“…A CDF most commonly arises in the setting of choledocholithiasis, cholelithiasis, or a perforated duodenal ulcer [1], [2], [3], [4], [5]. CDFs have also been reported as a complication secondary to recurrent biliary infections, adjacent neoplasm, tuberculosis, radiation, and iatrogenic injury [6], [7], [8]. To the best of our knowledge, there has been only one reported case of a CDF occurring in the setting of Crohn’s disease (CD) to date [9].…”