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• W2978334833 abstract "A 93 year-old female presented with abdominal pain, nausea and vomiting that began 2 hours after eating. She had a history of gallstone-induced pancreatitis 2 weeks earlier with unsuccessful ERCP at that time secondary to ampullary edema. Examination revealed right upper quadrant tenderness with positive murphy's sign, no generalized abdominal tenderness and no jaundice was noted. Laboratory analysis revealed WBC of 25bil/l, ALT 179U/L, AST 390U/L and ALK phos.173 U/L and total bilirubin is 2.4mg/dl with 1.4mg/dl being direct portion. Right upper quadrant abdominalultrasound showed intra and extra hepatic biliary dilatation. Intravenous antibiotics and fluids for ascending cholangitis were given. Same day ERCP revealed bulging and edematous major papilla, bile and pus extruding from an opening near the ampulla (Figure 1A, 1B) suggesting Choledochoduodenal fistula (CDF), injected contrast demonstrated dilated common bile duct and multiple filling defects (Figure 2). Sphincterotomy connecting the CDF and the major papilla with balloon dilatation was performed and the stone was extracted. Biliary enteric fistula (BEF) can occur between any segment of the biliary system and the intestine, the most common between gall bladder and duodenum (62%). Li et al. showed that 50 cases out of 1200 patients with biliary disease had CDF with incidence of 4.2%. Spontaneous BEF occur secondary to stones, malignancy, crohn's, trauma, tuberculosis or metallic biliary stent. Wu et al showed the most common presenting symptom is epigastric pain (80%), cholangitis (54%) and vomiting (10%). This case had typical presentation but subacute despite pus formation as the pus was discharging through the CDF and not from common nile duct due (CBD) to its obstruction by stone. Plain films show pneumobilia (30%), ectopic stone is diagnostic if seen (3%), ERCP is the most common and effective method for diagnosis, CT can be helpful in determining the location of the fistula, upper gastrointestinal study with barium is very specific if positive as it shows the fistulous tract and ultrasound can be helpful. Distal CDF connects any segment of the intestine with distal 2 cm of CBD can be managed endoscopically but the proximal CDF, which drains elsewhere 2 cm and above the junction of CBD to the papilla will be treated surgically only.Figure 1Figure 2Figure 3" @default.
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• W2978334833 date "2016-10-01" @default.
• W2978334833 modified "2023-09-29" @default.
• W2978334833 title "Spontaneous Choledochoduodenal Fistula with Purulent Discharge Treated Endoscopically" @default.
• W2978334833 doi "https://doi.org/10.14309/00000434-201610001-02580" @default.
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