Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration

Abstract

Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct.

Choledochoduodenal fistula due to peptic duodenal ulcer diagnosed by X-barium meal study: interest of medical treatment

“…Duodenal peptic ulcer communicates usually duodenal bulb with biliary tract into the common bile duct. CDF can be caused by many affections: cholelithiasis, choledocholithiasis, iatrogenic injury, duodenal diverticula, para duodenal abscess, Crohn's disease, liver transplantation, metallic biliary stent placement, cancer of the upper digestive tract and even duodenal tuberculosis [ 4 , 10 , 11 ]. In recent years, the duodenal peptic ulcer is becoming a rare etiology of these CDFs, because of the control and the effectiveness of ulcer drugs than before [ 4 ].…”

“…In some cases, the presence of an internal biliary fistula can be suggested by the findings of pneumobilia, atrophic gallbladder and biliary stones [ 12 ]. The accidental discovery of air within the biliary tree on the abdominal X-ray [ 11 ] or reflux of contrast in the biliary tree on X-barium meal must suspect the diagnosis of CDF [ 3 ]. Oeso-gastroduodenal endoscopy allows the direct visualization of duodenal ulcer, bulbar stenosis and CDF.…”

Taking an Alternate Route Home: Stenting of Choledochoduodenal Fistula

“… 1 - 3 Tuberculous duodenal ulcers are also reported to cause CDF. 4 These fistulas may form spontaneously as a complication from metallic biliary stents with underlying malignancy. 5 The mechanism of CDF may occur as a result of increasing pressure traversing along the pathway of the fistula from obstruction in the distal CBD.…”

Taking an Alternate Route Home: Stenting of Choledochoduodenal Fistula

“…[1][2][3] Tuberculous duodenal ulcers are also reported to cause CDF. 4 These fistulas may form spontaneously as a complication from metallic biliary stents with underlying malignancy. 5 The mechanism of CDF may occur as a result of increasing pressure traversing along the pathway of the fistula from obstruction in the distal CBD.…”