Upper Gastrointestinal Hemorrhage in a Patient with Choledochoduodenal Fistula

Toshihiro Tsubono, Fujio Sugimoto*, Kazuhiro Tsukada*, Katsuyoshi Hatakeyama*

Department of Surgery, Ryoutsu City Hospital
*First Department of Surgery, Niigata University School of Medicine

A case of parapapillary choledochoduodenal fistula complicated by active hemorrhage is reported herein. A 68-year-old man underwent percutaneous transhepatic gallbladder drainage for acute cholecystitis. Cholangiography through the biliary drain disclosed a bile duct stone. Choledochoduodenal fistula developed one week after biliary drainage. He underwent cholecystectomy and exploration of the common bile duct. A T-tube was placed in the common duct. On postoperative day 13, three weeks after developing the fistula, he suffered hemobilia and massive rectal bleeding with shock. Endoscopic hemostasis or arterial embolization was impossible. Exploration of the duodenum demonstrated active bleeding from the fistula. Hemostasis was obtained by placing a suture ligature into the fistula. No further bleeding or cholangitis occurred. Active hemorrhage from choledochoduodenal fistula is a rare but possible complication in the early period after developing the fistula. It is necessary to keep hemorrhagic complication in mind in the management of choledochoduodenal fistula.

Key words
choledocholithiasis, parapapillary choledochoduodenal fistula, upper gastrointestinal hemorrhage

Reprint requests
Toshihiro Tsubono First Department of Surgery, Niigata University School of Medicine
1-757 Asahimachi-dori, Niigata City, 951 JAPAN

Accepted
September 8, 1993

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