Rossi J A, Sollenberger L L, Rege R V, Glenn J, Joehl R J
Arch Surg. 1986 Aug;121(8):908-12. doi: 10.1001/archsurg.1986.01400080050009.
We reviewed records of 18 patients with external duodenal fistula. Fourteen patients developed duodenal fistulas following an operation, two following abdominal trauma, and two as a complication of other diseases. Copious drainage of intestinal juice from the abdomen was the most common presenting sign. Contrast fistulography, upper gastrointestinal tract roentgenography, and T-tube cholangiography were useful diagnostic studies. Nine patients were treated nonoperatively; nine patients required at least one operation. Complications occurred frequently; of special interest were three patients who developed postoperative acute cholecystitis. Six patients died (33% mortality). Factors associated with mortality were advanced age (greater than 65 years), uncontrolled infection and multiple organ failure, high-output fistula, malnutrition, delay in diagnosis (more than three days), and multiple reoperations to treat the fistula or complications. External duodenal fistula continues to be a life-threatening problem whether it is postoperative, posttraumatic, or secondary to a disease process.
我们回顾了18例十二指肠外瘘患者的病历。14例患者在手术后发生十二指肠瘘，2例在腹部创伤后发生，2例作为其他疾病的并发症。腹部大量肠液引流是最常见的表现体征。瘘管造影、上消化道X线造影和T管胆管造影是有用的诊断性检查。9例患者接受非手术治疗；9例患者至少需要进行一次手术。并发症频繁发生；特别值得关注的是3例发生术后急性胆囊炎的患者。6例患者死亡（死亡率33%）。与死亡率相关的因素包括高龄（大于65岁）、感染控制不佳和多器官功能衰竭、高流量瘘、营养不良、诊断延迟（超过三天）以及为治疗瘘或并发症而进行的多次再次手术。无论是术后、创伤后还是继发于疾病过程，十二指肠外瘘仍然是一个危及生命的问题。
