Selective Management for Gastrointestinal Hemorrhage caused by Choledochoduodenal Fistula

• Published in: Siriraj Medical Journal
• Main Authors: Pawan Chansaenroj, Stephanie Wood, Stanley J Rogers, John P Cello
• Format: Article
• Language: English
• Published: Faculty of Medicine Siriraj Hospital 2017-03-01
• Subjects: Choledochoduodenal fistula; choledochoenteric fistula; gastrointestinal hemorrhage (Siriraj Med J 2017;69: 97-101)
• Online Access: http://www.smj.si.mahidol.ac.th/sirirajmedj/index.php/smj/article/view/204/728

Background: To report a patient of choledochoduodenal fistulae (CDF) who presented with melena and review a specific treatment for CDF. Methods: This study was designed as a retrospective chart review using patient’s clinical data, imaging, endoscopic report, treatment review, and literature review for treatment options. Results: A 74-year-old female presented with diffuse, non-tender abdominal pain and associated melena for one week. Physical examination showed mildly icteric sclera and mild epigastric tenderness on deep palpation. Initial diagnoses included cholangitis with anemia and acute kidney injury. Computed tomography of the abdomen revealed dilated common bile duct (CBD) with a likely 1 cm stone at the distal common bile duct. The patient was given intravenous antibiotic and proper fluid administration. An ERCP was performed noting a fistula from the bile duct to the 2nd part of the duodenum with stone impaction. Sphincterotomy was performed from papilla to fistula. Balloon extraction of 1 cm stone from the CBD was done. Conclusion: The clinical presentation of CDF is generally quite nonspecific. In this case report, we present a presentation of a patient with gastrointestinal hemorrhage as an example of the presentation of CDF associated with a CBD stone. This study also discussed recent data concerning proposed treatment of CDF.