Observations on management of choledochoduodenal fistula due to penetrating peptic ulcer.

Perforation into the biliary tract is a rare complication of benign peptic ulcer disease. This report describes our experience with 4 patients having this problem. The resulting choledochoduodenal fistula itself causes no unique symptoms in most cases. The diagnosis, hithertofore unsuspected, is most commonly made during barium examination of the upper gastrointestinal tract in patients with typical complaints of ulcer disease. Endoscopy and retrograde cholangiography may be useful to define the pathologic anatomy and to distinguish peptic ulcer disease from primary biliary tract disease or malignant ulcer. Medical management of the underlying ulcer disease with cimetidine and antacids usually suffices to relieve symptoms and to allow healing of the fistula. Surgery becomes necessary if biliary stenosis or cholangitis occurs, or if other aspects of the ulcer disease mandate operative treatment.