The management of a duodenal fistula involving the right hepatic duct: a rare case report

The formation of an internal fistula between the biliary system and the gastrointestinal tract is a rare condition with various etiologies, predominantly associated with recurrent chronic inflammation of the biliary system and tumors. Patients with this condition may lack specific clinical manifestations, presenting with symptoms such as abdominal pain, fever, jaundice, or may show no clinical signs at all. Common types of internal fistulas include cholecystoduodenal fistula, cholecystocolonic fistula, and choledochoduodenal fistula. Among these, the right hepaticoduodenal fistula is extremely rare and seldom reported in clinical literature. We herein report a case of right hepaticoduodenal fistula and analyze its mechanism, treatment principles, and preventive measures through a literature review.

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

Peptic ulcer disease (PUD) is a very common condition, with an annual incidence ranging from 0.1% to 0.3% and a lifetime prevalence ranging from 5% to 10%. If not treated, it can lead to severe complications such as gastro-intestinal bleeding, perforation, or entero-biliary fistula. Entero-biliary fistulas and especially choledocho-duodenal fistula (CDF) are a rare, but relevant and important diagnosis, which can lead to several complications such as gastric outlet obstruction, bleeding, perforation, or recurrent cholangitis. In this article, we present the case of an 85-year-old woman with PUD complicated with gastro-intestinal bleeding and a CDF. We also performed a review of the literature to search for pre-existing cases with this atypical clinical presentation. The aim was to raise awareness among surgeons and clinicians by offering a summary of different types of entero-biliary and especially CDF, existing diagnostic investigations, and management.

Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

Gallstone ileus is a rare condition characterized by mechanical obstruction of the intestine due to gallstone impaction. Diagnosis is based on clinical history, symptoms, and characteristic Computed Tomography (CT) scan findings. Treatment typically involves surgical extraction of gallstones, with laparoscopy as an effective and potentially safer approach. Here, we describe a case of an 84-year-old woman with gallstone ileus presenting with small bowel obstruction.

Secondary Choledocholithiasis in Obstructive Jaundice Patient due to Choledochoduodenal-fistula Stricture

Choledochoduodenal fistula (CDF) is a rare condition marked by an abnormal connection between the biliary duct and duodenum. The common etiology of secondary CDF are cholecystolithiasis, tumor, and duodenal ulcer. CDF may also caused by prior inflammatory condition or as a complication of radiation therapy. Management for this case is based on the patient condition. Herein we aimed to present a case of secondary choledocholithiasis due to stricture in the CDF which presented with cholangitis treated by self-expanding metal stent (SEMS) for biliary drainage. Patient admitted with jaundice, fever, right upper quadrant pain, and history of cholecystectomy. Diagnosis of CDF was determined by endoscopic retrograde cholangiopancreatography (ERCP) and followed by putting biliary stent for urgent biliary drainage. The follow up result after stent removal was excellent.

Unusual Presentation of Bouveret Syndrome Resulting in Both Gastric Outlet Obstruction and Small Bowel Obstruction with Perforation

Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day's duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for choledocholithiasis with acute cholangitis in her home country, Scotland. Unfortunately, while visiting family in the United States, her PTCD became dislodged, and she developed progressive worsening abdominal pain. Computerized tomography of her abdomen showed pneumobilia, perigastric inflammation, a contracted gallbladder, small bowl inflammation with a likely transition point at the mid-jejunum, and a probable duodenal mass. The patient underwent an exploratory laparotomy with intraoperative findings of choledochoduodenal fistula with coincident gastric and small bowel obstruction (SBO) secondary to three large, mixed gallstones. One 3 cm gallstone was located at the pylorus and two (2.3 and 3 cm) gallstones were isolated in the mid-jejunum, with one of those causing isolated transmural pressure necrosis with subsequent perforation. Bouveret syndrome is a rare cause of gastric outlet obstruction (GOO) that manifests via an acquired cholecystoenteric fistula. Our patient presented with a concomitant GOO and SBO with perforation of the mid-jejunum. Timely diagnosis of Bouveret syndrome is essential, as most causes require emergent surgical intervention.

A Rare Presentation of Choledochoduodenal Fistula Due to Ovarian Cancer Metastasis

Choledochoduodenal fistula (CDF) is an abnormal communication between the common bile duct and the duodenum. It accounts for about 5% to 25% of the total biliary fistulas and is usually due to a perforated duodenal ulcer, choledocholithiasis, and complications secondary to tuberculosis or could be iatrogenic. Primary intrabilliary tumors usually cause obstructive jaundice and rarely biliary metastasis arising from other organs like colon, breast, and lungs can cause obstructive jaundice. There has been a case report of metastasis from ovarian cancer to the major papilla of the duodenum but no reported cases of it causing a CDF. We report a rare case of an 83-year-old female with ovarian cancer who developed a metastatic lesion to the duodenum eventually resulting in a CDF.

A Complicated Peptic Ulcer With Bleeding, Gastric Outlet Obstruction, and Choledochoduodenal Fistula

Although peptic ulcer disease (PUD) is a common entity, the rate of its complication has decreased with the advent of proton pump inhibitors. We present a case of complicated PUD in a 49-year-old male patient having a rare combination of bleeding, gastric outlet obstruction, and a large choledochoduodenal fistula (CDF) who presented with shock. After resuscitation and investigations, ligation of bleeder via duodenotomy, Roux-en-Y choledochojejunostomy, and gastrojejunostomy was done for ulcer bleeding, CDF, and pyloric stenosis respectively. The patient improved after surgery. As with other emergency surgery, minimizing morbidity and mortality remains the principle of management. The best treatment in this situation irrespective of hemodynamic stability is surgery, which is a one-time and best treatment for bleeding, obstruction, and CDF.

Choledochoduodenal Fistula during Chemotherapy with Brentuximab Vedotin for Methotrexate-associated Lymphoproliferative Disorder

We herein report a patient with a history of rheumatoid arthritis treated with methotrexate, which caused methotrexate-associated lymphoproliferative disorder and obstructive jaundice due to an enlarged lymph node. The obstructive jaundice was treated with endoscopic biliary stenting. A histopathological examination revealed features of Hodgkin's lymphoma, and chemotherapy with brentuximab vedotin was administered. Cholangiography and duodenoscopy after four rounds of chemotherapy revealed a choledochoduodenal fistula that developed in response to chemotherapy. It should be noted that, in cases of lymphoma infiltrating the gastrointestinal wall, fistulae can occur because of rapid regression due to regimens comprising monoclonal antibodies, such as rituximab and brentuximab vedotin.

A case of choledochoduodenal fistula - an unusual case report

Choledochoduodenal fistula (CDF) is an abnormal communication between the choledochus and the duodenum, accounts for 5–25% of all internal biliary fistulas. Here, we report a case of CDF secondary to chronic duodenal ulcer who presented with cholangitis. CDF is suspected in case of pneumobilia, and surgery is recommended for refractory cases.

Peptic ulcers accompanied with gastrointestinal bleeding, pylorus obstruction and cholangitis secondary to choledochoduodenal fistula: A case report

Peptic ulcers are an extremely common condition, usually occurring in the stomach and proximal duodenum. However, cases of peptic ulcers accompanied with multiple complications are extremely rare and hard to treat. The present case reinforces the requirement for the early recognition and correct treatment of peptic ulcers accompanied with multiple complications. A 67-year-old man presented with recurrent abdominal pain, fever and melena. The laboratory results showed anemia (hemoglobin 62 g/l) and hypoproteinemia (23 g/l). Abdominal imaging examinations revealed stones in the gallbladder and right liver, with air in the dilated intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography failed due to a deformed pylorus. The patient was finally diagnosed with peptic ulcers accompanied with gastrointestinal (GI) bleeding, pylorus obstruction and cholangitis secondary to a choledochoduodenal fistula during an emergency pancreatoduodenectomy, which was performed due to a massive hemorrhage of the GI tract. The patient recovered well after the surgery.

Choledochoduodenal fistula: An unusual cause of recurrent cholangitis in children

Choledochoduodenal fistula (CDF) is an unusual clinical entity and a diagnostic challenge in children. We herein present CDF as an unusual cause of recurrent cholangitis in a 6-year-old child. To the best of our knowledge, this is the youngest patient reported until date. In this paper, we also highlight possible etiologic factors, presenting symptoms, diagnostic methods, and treatment modalities of CDF.