Hook-shaped distal common bile duct due to peptic ulcer mimicking cholangiocarcinoma

Internal and spontaneous bilio-digestive fistulas, without primary biliary disease, are an infrequent complication of the upper digestive tract. We report a case of a Hook-shaped distal common bile duct due to peptic ulcer mimicking cholangiocarcinoma.

A 63-year-old patient, with no medical history, presented to the emergency department with recent jaundice. Laboratory tests showed cholestasis, and high bilirubin levels. Cholangio-MRI found a stricture in the distal common bile duct with multiple hepatic lesions which could be abscesses or secondary lesions. An endoscopic ultrasound was attempted to confirm the malignant nature of the CBD stricture but it was not possible due to a duodenal stenosis. Peptic ulcer stenosis complicated with distal CBD retraction and choledochoduodenal fistula was then suspected. The patient was put on proton pump inhibitors and antibiotics with favorable clinical, biological and endoscopic evolution.

Choledoco-duodenal fistulas resulting from peptic ulcers are rare. The incidence of fistulas associated with peptic ulcer disease has declined significantly in recent years. This reduction is largely attributed to advancements in medical treatment for ulcers. Patients with choledoco-duodenal fistula often present with nonspecific symptoms, making the condition challenging to diagnose.

Spontaneous bilio-digestive fistulas, in the absence of primary biliary disease, are a rare complication of the upper digestive tract. Conservative treatment is recommended for CDF caused by duodenal peptic ulcers.