A Case of Choledochoduodenal Fisutula Developed by Duodenal Ulcer

Koichi Inoue, Takayuki Tajima, Masami Taniguchi, Teruji Sugita and Yosifumi Kise^*

Department of Surgery, Yamachika Memorial Hospital ^*Department of Surgery, Tokai University School of Medicine

Choledochoduodenal fistula complicating duodenal ulcer disease is a rare occurrence. We report such a case in a 25-year-old man admitted to our hospital with chief complaint of vomiting and upper abdominal pain. Abdominal ultrasonography showed pneumobilia in the ballbladder and intrahepatic bile ducts. Upper gastrointestinal contrast radiography showed bulbar stricture and bulbar dilatation but no evidence of a fistula. Percutaneous transhepatic cholangiography (PTC) showed a choledochoduodenal fistula slightly proximal to the bulbar stricture. The patient was successfully treated by distal gastrectomy by the Billroth II method leaving the ulcer intact (Finsterer-Bancroft operation) and by hepaticojejunostomy to decompress the duodenal stump. Medical management with recent anti-ulcer drugs for choledochoduodenal fistula has also been reported to yield good results. Our patient, however, required surgery because of the bulbar stricture and the location of the choledochoduodenal fistula.

Key words
choledochoduodenal fistula, duodenal ulcer

Reprint requests
Koichi Inoue Department of Surgery, Yamachika Memorial Hospital 3-9-14 Koyawata, Odawara-City, 256-0815 JAPAN

Accepted
September 20, 2000

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