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Post Cholecystectomy Choledochoduodenal Fistula: A Case Report

Anip Joshi1, Samita Shakya2, Surakshya Thapa2

  • 1Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Mahabaoudha, Kathmandu, Nepal.

JNMA; Journal of the Nepal Medical Association
|July 14, 2025
PubMed

Insights

Choledochoduodenal fistula, an abnormal bile duct connection, often stems from gallstones. This case highlights surgical management for a patient with long-standing bile duct stones and fistula post-gallbladder removal.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Gastroenterology

Background:

  • Choledochoduodenal fistula is an abnormal communication between the common bile duct and duodenum.
  • Common etiologies include cholecystolithiasis, iatrogenic factors, choledocholithiasis, and chronic duodenal ulcers.

Observation:

  • A case of choledochoduodenal fistula secondary to long-standing choledocholithiasis after cholecystectomy is presented.
  • The patient experienced intermittent abdominal pain for three years, with diagnosis confirmed via Endoscopic Retrograde Cholangiopancreatography.
  • Recurrent pain and choledocholithiasis necessitated surgical intervention.

Findings:

  • Endoscopic Retrograde Cholangiopancreatography is crucial for diagnosing choledochoduodenal fistulas.
  • Surgical intervention is indicated for choledochoduodenal fistula associated with recurrent pain and choledocholithiasis.
  • Surgery is recommended for refractory, complicated, or large fistulas, especially when medical treatment fails.

Implications:

  • This case underscores the importance of considering choledochoduodenal fistula in patients with recurrent cholangitis.
  • It highlights surgical treatment as a viable option for choledocholithiasis complicated by choledochoduodenal fistula.
  • Effective management strategies are crucial for improving patient outcomes in complex biliary tract conditions.

Keywords:
CBD explorationcholedochoduodenal fistulacholedocholithiasis

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