Spontaneous duodenocutaneous fistula: a rare complication of duodenal ulcer

Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication of duodenal ulcer disease, most often felt to occur following ulcer surgery. The development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has not been hitherto reported. A middle aged man with a history of peptic ulcer for more than 10 years, and a vagotomy and pyloroplasty 15 months earlier, presented with an asymptomatic duodenocutaneous fistula, presumably secondary to a perforated duodenal bulb ulcer. Successful healing of the fistula was accomplished by non-surgical therapy consisting of nasogastric suction, intravenous alimentation and parenteral cimetidine over a 4-week period.