Clinical analysis of choledochoduodenal fistula with cholelithiasis in Taiwan: Assessment by endoscopie retrograde cholangiopancreatography

Bor Shyang Sheu, Jeng Shiann Shin, Xi Zhang Lin, Ching Yih Lin, Chiung Yu Chen, Ting Tsung Chang, Chi Yi Chen, Pin Nan Cheng

研究成果: Article同行評審

20 引文 斯高帕斯(Scopus)


Objectives: Choledochoduodenal fistula (CDF) is occasionally found during endoscopic retrograde cholangiopancreatography (ERCP). Cholelithiasis is suspected to be the leading cause in some endemic areas. We focus on this cause of CDF to determine which clinical characteristics are relevant to formation of fistulas and to learn whether CDF of various types would imply different clinical significance. Methods: In 1882 ERCP studies from 1988 to 1993, we found 27 CDF with cholelithiasis in 1066 patients. Their clinical backgrounds and ERCP findings were compared with those of 492 patients who had cholelithiasis but no CDF. Results: The prevalence of CDF was 2.53%. A longer past history of biliary stones, recurrent biliary tract infection (BTI), and the presence of common bile duct stones (CBS) were factors relevant to the formation of fistula. In the case of 24 distal fistulas, including seven of type I and 17 of type II, there was concurrent distal CBS. Three cardinal features of fistula of the distal type were: 1) the length of CDF was less than 1.5 cm, 2) its orifice was just around or on the papillary fold, and 3) all cases of distal type II had prominent pneumobilia, less jaundice, and larger CBS than type I. Aggressive endoscopic or surgical treatment of distal type CDF decreased the recurrence of BTI, as indicated by surveillance for 1 yr. Three fistulas of the proximal type were longer and drained into the duodenum far from the papilla. All of these cases deserved early surgical intervention. Conclusions: CDF really serves as a chronic sequel of cholelithiasis. Different clinical features of CDF of various types help one to establish diagnosis and treatment. To avoid recurrence of BTI, aggressive therapy to correct CDF is mandatory.

頁(從 - 到)122-126
期刊American Journal of Gastroenterology
出版狀態Published - 1996 1月

All Science Journal Classification (ASJC) codes

  • 肝病
  • 消化內科


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