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Published on: February 28, 2025
Choledochoduodenal fistula in the setting of Crohn's disease
Shane Knipping1, Ravi Rajpoot1, Roozbeh Houshyar1
1Department of Radiology, UC Irvine Medical Center, 101 The City Drive South, Orange, CA 92868, USA.
Insights
A rare choledochoduodenal fistula, an abnormal connection between the bile duct and duodenum, was identified in an asymptomatic patient. This finding suggests a potential link between inflammatory bowel disease and biliary fistulas.
Area of Science:
- Gastroenterology and Hepatology
- Diagnostic Imaging
Background:
- Spontaneous choledochoduodenal fistulas are rare biliary-enteric communications.
- Typically secondary to peptic ulcer disease, gallstones, or iatrogenic causes.
- Often asymptomatic, posing diagnostic challenges without imaging.
Observation:
- A case of a 74-year-old female patient with a history of Crohn's disease.
- The patient was asymptomatic and found to have a choledochoduodenal fistula.
- Magnetic resonance cholangiopancreatography (MRCP) confirmed the fistula.
Findings:
- The choledochoduodenal fistula was incidentally discovered via MRCP.
- The fistula's etiology was suspected to be related to the patient's underlying Crohn's disease.
- This presentation highlights a less common cause of biliary-enteric fistula.
Implications:
- Suggests inflammatory bowel disease as a potential, albeit rare, cause of choledochoduodenal fistulas.
- Underscores the importance of advanced imaging like MRCP in diagnosing subtle gastrointestinal and biliary abnormalities.
- May prompt consideration of biliary complications in patients with chronic inflammatory bowel conditions.
Abstract:
Of all the spontaneous fistulas that occur between the extrahepatic biliary system and the intestine, a choledochoduodenal fistula is rarely seen. When it does occur, it is most often secondary to a perforated duodenal ulcer, choledocholithiasis, or cholelithiasis. It may also be seen following complications related to iatrogenic injury or tuberculosis. Generally, choledochoduodenal fistulas are asymptomatic, but may present with vague abdominal pain, fever, and other symptoms related to cholangitis. As a result, they can be difficult to diagnose clinically before imaging is obtained. We present a case of a 74 year old, asymptomatic, female with a past medical history significant for Crohn's disease who was found to have a choledochoduodenal fistula demonstrated on MRCP, possibly secondary to her underlying inflammatory bowel disease.
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