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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
Summary
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.
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