Unexpected problems of external choledochoduodenostomy. Fiberscopic examination in 15 patients.

Fiberscopic examination was carried out to investigate the condition of the stoma and bile duct and to assess the postoperative effects of the procedure on the upper gastrointestinal tract in 15 patients who received external side-to-side choledochoduodenostomy. The stoma remained patent, with a round or oval shape, in all 15 patients. Residual sutures were found at the stoma in 4 of 15 patients, 3 of whom had inflamed stomal mucosa. Food debris was found in the blind segment in four of seven patients. but all 4 had large stomas. In three patients food debris was floating and easily discharged through a stoma. In the other patient much food debris had accumulated and was firmly attached to the mucosal surface. Gastroduodenal lesions were noted in 9 of 15 patients: redness at the antrum in 3, multiple erosions at the antrum in 2, gastric ulcer in 1, redness at the bulbus in 1 and duodenal ulcer in 2. Bile reflux into the stomach was found in 9 of 15 patients, 5 of whom had gastric lesions, and duodenal mucosa was constantly exposed to bile in all 15 patients.