The aetiology and significance of distal choledochoduodenal fistula

Abstract

Thirteen patients undergoing investigation for biliary or pancreatic disease were found at endoscopic retrograde cholangiopancreatography to have unsuspected choledochoduodenal fistula. In only one patient could the presenting symptoms be directly attributed to the fistula. Ten of the thirteen patients had previously undergone exploration of the common bile duct and instrumentation at surgery is postulated as being the most likely cause of these fistulae. Treatment of the uncomplicated fistula appears unnecessary.

Choledochoduodenal fistula caused by blunt abdominal trauma in a child

“…Treatment of an uncomplicated fistula appears unnecessary [12]. Symptomatic CDF may be managed by endoscopic sphincterotomy or surgical intervention.…”

Endoscopic management of retained bile stones with an indwelling T-tube

“…One patient with JDD was found to have a parapapillary choledochoduodenal fistula. He had CBD exploration, and surgical instrumentation is thought to be the most likely cause of this fistula [19]. The fistula was wide enough to admit standard ERCP cannulation.…”

Adenosquamous Carcinoma of the Common Bile Duct with Choledochoduodenal Fistula

“…endoscopic procedure [1]. Gall stones can induce a choledochoduodenal fistula by stone erosion of the wall of the biliary tract and then penetrating into the duodenum [2].…”

“…The treatment of an uncomplicated choledochoduodenal fistula is still controversial. Spontaneous healing of a choledochoduodenal fistula is usually noted in patients with the fistula caused by previous instrumentation or by duodenal ulcers after antiulcer drug therapy [1,3]. However, surgical treatment is indicated if a choledochoduodenal fistula induces a complication such as cholangitis, or if the fistula is caused by malignancy.…”

“…The formation of a choledochoduodenal fistula is usually caused by iatrogenic instrumentation, choledocholithiasis, or duodenal ulcer [1][2][3]. Rarely, the fistula may be a complication secondary to an occult malignancy.…”