Feller E R, Warshaw A L, Schapiro R H
Gastroenterology. 1980 Jan;78(1):126-31.
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.
十二指肠溃疡穿孔至胆道是良性消化性溃疡疾病的一种罕见并发症。本报告描述了我们对4例患有此问题患者的治疗经验。多数情况下，由此形成的胆总管十二指肠瘘本身不会引起独特症状。此前未被怀疑的这种疾病，最常见的诊断是在患有典型溃疡病症状的患者进行上消化道钡餐检查时作出。内镜检查和逆行胆管造影可能有助于明确病理解剖结构，并将消化性溃疡疾病与原发性胆道疾病或恶性溃疡区分开来。使用西咪替丁和抗酸剂对潜在的溃疡疾病进行药物治疗通常足以缓解症状并使瘘管愈合。如果发生胆管狭窄或胆管炎，或者溃疡疾病的其他方面需要手术治疗，则有必要进行手术。
