Akaydin Murat, Demiray Okan, Ferlengez Ekrem, Erozgen Fazilet, Ersoy Yeliz E, Er Muzaffer
Universal Hospitals Group, General Surgery Clinic, Universal Aksaray Hospital, Istanbul, Turkey.
2General Surgery Clinic, Taksim Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey.
Indian J Surg. 2018 Jun;80(3):216-220. doi: 10.1007/s12262-016-1569-8. Epub 2016 Dec 24.
Choledochoduodenal fistula (CDF) is an abnormal passage between the choledochus and duodenum. The most common causes of CDF are cholelithiasis, duodenal ulcer, and tumors. There are mainly two types of fistulas depending on the location. Type 1 is usually present on the longitudinal fold just close to the papilla. Type 2 is present at the duodenal mucosa adjacent to the longitudinal fold and probably caused by larger stones, duodenal ulcer penetration, impacted cystic duct stones, and as a complication of laparoscopic cholecystectomy. In this study, we investigate the characteristics of our patients those were diagnosed with CDF. This is a descriptive study. We retrospectively obtained the data of 21 patients with spontaneous CDF out of 2430 endoscopic retrograde cholangiopancreaticography (ERCP) patients between 2000 and 2014. We analyzed the laboratory results, demographic and etiological features, major clinical presentations, diagnostic methods, and treatment modalities of the patients. The mean age of the 21 patients was 66.6 ± 2.2 years and a female to male ratio was 12:9. In ten patients, interventional procedures were performed via fistulotomy, not through the papilla. The eventual diagnosis was tumor in five patients and stone or sludge in bile ducts in 14 patients. In the remaining two patients, no reason was found as a cause of CDF. Whipple operation was performed in one patient and stents were placed in three patients for malignacy. Among the 14 patients with sludge or stone in bile ducts, ERCP has been therapeutic in ten. One of the remaining patients has been operated for proximal fistula and underwent choledochus exploration and repair of fistula over a T-tube. In the second patient, stone extraction and T-tube drainage were performed. In patients who had bile duct obstruction and got over of jaundice afterwards, one of the most important reasons of this recovery is the development of spontaneous choledochoduodenal fistula. Even if it is very rare, malignancy can be observed in this area. Therefore, it is extremely important to evaluate the papillary area with ERCP and to conduct biopsy; this will make early diagnosis possible in many patients. In these patients, ERCP can both be diagnostic and therapeutic.
胆总管十二指肠瘘（CDF）是胆总管与十二指肠之间的异常通道。CDF最常见的病因是胆石症、十二指肠溃疡和肿瘤。根据位置不同，瘘主要有两种类型。1型通常位于靠近乳头的纵襞上。2型位于与纵襞相邻的十二指肠黏膜处，可能由较大的结石、十二指肠溃疡穿孔、胆囊管结石嵌顿以及腹腔镜胆囊切除术的并发症引起。在本研究中，我们调查了被诊断为CDF的患者的特征。这是一项描述性研究。我们回顾性收集了2000年至2014年间2430例接受内镜逆行胰胆管造影（ERCP）患者中21例自发性CDF患者的数据。我们分析了患者的实验室检查结果、人口统计学和病因学特征、主要临床表现、诊断方法和治疗方式。21例患者的平均年龄为66.6±2.2岁，男女比例为12:9。10例患者通过瘘管切开术进行介入操作，而非通过乳头。最终诊断为5例患者患有肿瘤，14例患者胆管内有结石或胆泥。其余2例患者未发现CDF的病因。1例患者接受了惠普尔手术，3例恶性肿瘤患者放置了支架。在14例胆管内有胆泥或结石的患者中，10例ERCP治疗有效。其余患者中的1例因近端瘘接受了手术，进行了胆总管探查并通过T形管修复瘘管。第2例患者进行了结石取出和T形管引流。在胆管梗阻后黄疸消退的患者中，这种恢复的最重要原因之一是自发性胆总管十二指肠瘘的形成。即使非常罕见，该区域也可能观察到恶性肿瘤。因此，通过ERCP评估乳头区域并进行活检极其重要；这将使许多患者能够早期诊断。在这些患者中，ERCP既能诊断又能治疗。
