Aitken R J, Bornman P C, Dent D M
S Afr Med J. 1986 May 24;69(11):707-8.
A penetrating duodenal ulcer may occasionally erode into the common bile duct and form a choledochoduodenal fistula. Such a fistula occurring simultaneously with a pancreatic duodenal fistula is reported. The presenting features of these fistulas are those of the ulcer and confirmation of the fistula may be difficult, although use of endoscopic retrograde cholangiopancreatography has greatly facilitated their diagnosis. In this case both fistulas could be cannulated through the base of the ulcer. The majority of these fistulas heal spontaneously with intensive medical management. The remainder require surgery, and a conservative approach avoiding direct interference with the fistula should be adopted. Drainage procedures are rarely required and once closed the fistulas usually cause no further problem.
穿透性十二指肠溃疡偶尔可侵蚀至胆总管，形成胆总管十二指肠瘘。本文报告了一例与胰十二指肠瘘同时发生的此类瘘管。这些瘘管的临床表现为溃疡的表现，瘘管的确诊可能困难，尽管内镜逆行胰胆管造影的应用极大地促进了其诊断。在该病例中，两个瘘管均可通过溃疡底部插管。这些瘘管中的大多数在强化内科治疗后可自行愈合。其余的则需要手术治疗，应采取避免直接干预瘘管的保守方法。很少需要引流程序，瘘管一旦闭合通常不会再引起问题。
