Clin Endosc.  2015 May;48(3):265-267. 10.5946/ce.2015.48.3.265.

Cholangitis Secondary to Food Material Impaction in the Common Bile Duct through a Choledochoduodenal Fistula

• Kang BK
• Park SM
• Kim BW
• Kim JS
• Kim JH
• Ji JS
• Choi H

• KMID: 2148578
• DOI: http://doi.org/10.5946/ce.2015.48.3.265

Abstract

Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.

Keyword

Biliary fistula; Cholangitis; Duodenal ulcer

MeSH Terms

Biliary Fistula
Cholangitis*
Common Bile Duct*
Duodenal Obstruction
Duodenal Ulcer
Duodenum
Fistula*
Humans
Sepsis

Figure

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  Fig. 1 Abdominal computed tomography. Air is present in the biliary tree (arrows).

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  Fig. 2 Duodenoscopy The orifice of the choledochoduodenal fistula with bubbles (arrows) is seen in the middle of a huge peptic ulcer.

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  Fig. 3 Follow-up duodenoscopy. Impacted food material is present at the orifice of the choledochoduodenal fistula.

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  Fig. 4 Tubography through percutaneous transhepatic bile drainage. The biliary tree is markedly dilated, and food material is impacted at the distal common bile duct (arrows).

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