Tonolini Massimo
Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy.
J Emerg Trauma Shock. 2013 Apr;6(2):146-7. doi: 10.4103/0974-2700.110814.
Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF) from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis) and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head) allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.
无既往手术或介入操作史的自发性气胆症提示存在异常的胆肠沟通，最常见的是与胆石症相关的胆囊穿孔。相反，十二指肠球部溃疡导致的胆总管十二指肠瘘（CDF）目前较为罕见，这反映了消化性疾病的低发病率。临床资料（发生于中年男性、有溃疡病史、无黄疸和胆管炎）与CT表现（包括气胆症、胆囊正常、十二指肠后部与胰头之间有瘘管粘连）相结合，有助于CDF的诊断，并与需要手术治疗的常见胆石症相关胆瘘相鉴别。相反，溃疡相关的CDF通过药物治疗有效，而手术仅用于症状控制不佳或出现严重并发症的情况。
