Choledochoduodenal fistula of ulcer etiology

Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

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Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

Case Reports in Gastroenterology ◽

10.1159/000477335 ◽

2017 ◽

Vol 11 (2) ◽

pp. 428-433 ◽

Cited By ~ 6

Author(s):

Hrudya Abraham ◽

Sajan Thomas ◽

Amit Srivastava

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Clinical Manifestations ◽

Rare Condition ◽

Endoscopic Retrograde ◽

Distal Common Bile Duct ◽

History Of ◽

The Common

Biliary sump syndrome is a rare condition. It is seen as a rare long-term complication in patients with a history of a side-to-side choledochoduodenostomy. In the era before endoscopic retrograde cholangiopancreatography, side-to-side choledochoduodenostomy was a common surgical procedure for the management of biliary obstruction. In the setting of a side-to-side choledochoduodenostomy, the bile does not drain through the distal common bile duct anymore. Therefore, the part of the common bile duct distal from the choledochoduodenostomy anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a 64-year-old man with a history of side-to-side choledochoduodenostomy who presented with manifestations of cholangitis. An endoscopic retrograde cholangiopancreatography confirmed a diagnosis of sump syndrome. The etiology, clinical manifestations, and treatment of biliary sump syndrome are discussed in this article.

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Foreign bodies of common bile duct

Kazan medical journal ◽

10.17816/kazmj81567 ◽

1997 ◽

Vol 78 (4) ◽

pp. 299-301

Author(s):

D. M. Krasilnikov ◽

M. I. Mavrin ◽

B. Kh. Kim

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Postoperative Period ◽

Foreign Bodies ◽

Endoscopic Retrograde ◽

Endoscopic Nasobiliary Drainage ◽

The Common ◽

Nasobiliary Drainage

After endoscopic retrograde pancreatocholangiography, endoscopic nasobiliary drainage and removal of external drains in the postoperative period sometimes fragments of catheters remain in the common bile duct. The left foreign bodies contribute to cholangitis, pancreatitis, mechanical jaundice and concrements formation.

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Duodenal peripapillary adenocarcinoma causing extrahepatic biliary obstruction and icterus in a cat

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v89i5.16954 ◽

2020 ◽

Vol 89 (5) ◽

pp. 273-277

Author(s):

T. Rick ◽

E. Stock ◽

I. Van de Maele ◽

E. Kammergruber ◽

J. Saunders

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Biliary Obstruction ◽

Ultrasound Examination ◽

Duodenal Wall ◽

Abdominal Ultrasonography ◽

Extrahepatic Biliary Obstruction ◽

History Of ◽

The Common ◽

Distal Aspect

A six-year-old, female, neutered domestic shorthair cat was presented with chronic weight loss and a two-day history of partial anorexia and lethargy. Abdominal ultrasonography revealed a regional thickening of the duodenal wall with loss of normal layering, a normally walled segmentally dilated distal aspect of the common bile duct containing slightly hyperechoic bile, and a mild to moderately enlarged major duodenal papilla. Based on the ultrasound examination, the primary differential diagnosis was a peripapillary duodenal neoplastic or less likely, an inflammatory or infectious process with secondary extrahepatic biliary obstruction. Postmortem examination revealed a duodenal, peripapillary adenocarcinoma with metastasis into the liver and lymph nodes, and external compressive obstruction of cystic- and common bile duct.

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Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

Journal of Clinical Imaging Science ◽

10.25259/jcis-17-2019 ◽

2019 ◽

Vol 9 ◽

pp. 23

Author(s):

Giulia Frauenfelder ◽

Annamaria Maraziti ◽

Vincenzo Ciccone ◽

Giuliano Maraziti ◽

Oliviero Caleo ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Acute Abdominal Pain ◽

Imaging Modality ◽

Biliary Duct ◽

History Of ◽

The Common ◽

Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

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Toothpick inside the Common Bile Duct: A Case Report and Literature Review

Case Reports in Medicine ◽

10.1155/2017/5846290 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

V. O. Brunaldi ◽

M. O. Brunaldi ◽

R. Masagao ◽

C. Silva ◽

H. Masuda ◽

...

Keyword(s):

Case Report ◽

Bile Duct ◽

Common Bile Duct ◽

Foreign Bodies ◽

Epigastric Pain ◽

Abdominal Ultrasound ◽

Mortality Rates ◽

High Morbidity ◽

Endoscopic Retrograde ◽

The Common

The incidence and prevalence of foreign body (FB) ingestion are difficult to estimate. Unlike other foreign bodies, the ingestion of a toothpick is very uncommon and carries high morbidity and mortality rates. We report a case of a 73-year-old female patient presenting mid-term epigastric pain. Abdominal ultrasound revealed a slightly dilated common bile duct (CBD) and magnetic resonance showed an irregular filling failure in distal CBD and gallstones. Endoscopic Retrograde Cholangiopancreatography revealed major papilla on the edge of a diverticulum and confirmed the distal filling failure. After sphincterotomy, a partially intact toothpick was extracted from the CBD. Neither fistulas nor perforation signs were found. Literature related to foreign bodies and toothpick ingestion was reviewed and some hypotheses to explain the reported case were created. To our knowledge, this is the first report of a toothpick lodged inside the biliary tract.

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