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Tubography through percutaneous transhepatic bile drainage. The biliary tree is markedly dilated, and food material is impacted at the distal common bile duct (arrows).
Source publication
Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a C...
Context in source publication
Context 1
... the CBD. The material was removed with endoscopic for- ceps. A percutaneous transhepatic bile drainage (PTBD) cath- eter was inserted into the CBD, and tubography showed food impaction with CBD dilatation (Fig. 4). After PTBD insertion, total bilirubin levels steadily decreased. To resolve the stenosis of the duodenal bulb and to seal the CDF, a partially covered self-expendable metallic stent (Hanarostent, duodenal/pyloric; M.I. Tech Co., Ltd., Seoul, Korea) was placed in the duodenum. The CDF was closed, and the stent was removed 6 weeks after insertion. Since impacted food material was still in the CBD, endoscopic retrograde cholangiography was performed to re- move the food material; however, this was not successful be- cause of the deformity of the duodenal bulb. We then recom- mended surgical management, but the patient refused because of poor general condition. The PTBD catheter was left in place, and medical therapy, including proton pump inhibitor and PTBD, was ...
Citations
... BEFs are usually diagnosed incidentally on radiography. 10 Management strategies for BEF vary because there are no established treatment guidelines. In general, treatment depends on correcting the underlying cause. ...
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.
... A similar aetiology of recurrent cholangitis was described in patients who had undergone biliary bypass or pancreatoduodenectomy [11]. Another case report revealed another rare mechanism, where the condition was attributed to food impaction through a choledochoduodenal fistula leading to obstructive jaundice with ascending cholangitis progressing to sepsis [12]. External compression of the biliary tree from a ruptured renal angiomyolipoma (AML) of the right kidney and mucinous cystic neoplasm of the liver with extrahepatic growth have been reported as rare causes of ascending cholangitis [13,14]. ...
Introduction: Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops because of stasis and infection in the biliary tract. The most frequent causes of biliary obstruction are biliary calculi, benign biliary stricture, and malignancy.Case presentation: Here we report a case presented with septic shock and acute ascending cholangitis on top of an altered anatomy in the form of disruption of the head and Wirsung duct of the pancreas, complete avulsion of the CBD at the ampulla of vater and deformed duodenal bulb after an old road traffic accident sustained thirty-five years back. Initial resuscitation, and antibiotic therapy with urgent decompression have been done. Definitive surgery has been performed in the form of dismantling of prior cholecystojejunostomy, exploration and resection of common bile duct with cholecystectomy and Roux-en-Y hepaticojejunostomy with adhesiolysis.Conclusions: Definitive surgery remained the mainstay of treatment for extrahepatic biliary and pancreatic trauma to prevent future life-threatening complications. MDT approach is the optimal choice for dealing with critically ill patients. Utilization of the full capabilities of endoscopic and interventional radiology services deemed mandatory for urgent and timely management.
... The above four cases and the present case are listed in Table 2. Regarding CDDF cases caused by a DU, the indications for surgical intervention are a gastric outlet obstruction (11)(12)(13), untreatable hemorrhagic DU (14) and cholangitis (15). The cases without the above complications were conservatively treated, including endoscopic treatment (13,(16)(17)(18)(19). ...
An 87-year-old woman on oral prednisolone was diagnosed with a cholecystoduodenal fistula (CDF) caused by a cytomegalovirus-associated duodenal ulcer (DU) and was managed conservatively. A CDF caused by a DU is extremely rare. Although surgical repair is recommended for the treatment of a CDF caused by cholecystolithiasis, appropriate treatment for CDF caused by a DU remains controversial. This case report of a CDF caused by a DU suggests that conservative treatment is feasible in the absence of DU-associated complications, such as an untreatable hemorrhage or obstruction; this finding is compatible with previously reported cases that were conservatively treated.
