Joshi Anip, Shakya Samita, Thapa Surakshya, Sultan Rifka, Rajbhandari Alish, Baral Piya
Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Mahabaoudha, Kathmandu, Nepal.
Bir nospiTal, NaTional Academy of Medical Sciences, Mahabaoudha, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2024 Nov;62(279):777-779. doi: 10.31729/jnma.8815. Epub 2024 Nov 30.
Choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum. The commonest cause is cholecystolithiasis, however, other causes are iatrogenic factors, bile duct stones (choledocholithiasis), and chronic duodenal ulcers. Here, we report a case of choledochoduodenal fistula secondary to long standing choledocholithiasis post cholecystectomy who presented with intermittent abdominal pain in the past three years which revealed choledochoduodenal fistula during Endoscopic Retrograde Cholangiopancreatography. As the patient had recurrent pain along with choledocholithiasis, surgical intervention was indicated. Choledochoduodenal fistula is suspected in case of recurrent cholangitis and surgery is recommended for refractory and complicated cases. Surgical treatment is also recommended for larger fistulas and especially with non-resolving medical treatment. This case highlights the treatment option for choledocholithiasis with choledochoduodenal fistula.
胆总管十二指肠瘘是胆总管与十二指肠之间的异常连接。最常见的病因是胆囊结石，然而，其他病因包括医源性因素、胆管结石（胆总管结石）和慢性十二指肠溃疡。在此，我们报告一例胆囊切除术后长期胆总管结石继发胆总管十二指肠瘘的病例，该患者在过去三年中出现间歇性腹痛，在内镜逆行胰胆管造影检查中发现胆总管十二指肠瘘。由于患者伴有胆总管结石且反复疼痛，故需进行手术干预。对于复发性胆管炎患者怀疑有胆总管十二指肠瘘，对于难治性和复杂性病例建议手术治疗。对于较大的瘘管，尤其是内科治疗无效的情况，也建议手术治疗。本病例突出了胆总管结石合并胆总管十二指肠瘘的治疗选择。
