Spontaneous choledocoduodenal fistula--due to chronic duodenal ulcer

A case of spontaneous choledocoduodenal fistula due to penetrating posterior duodenal ulcer is reported. The only presenting symptoms were pain and vomiting. There was no fever or recurrent jaundice which is usually expected in such a condition. The radiological findings included barium and air in the biliary tract. Biliary fistula are not uncommon. Although external biliary fistulae are seldom seen in present times, internal biliary fistulae are not a rare entity. Internal biliary fistulae are either spontaneous or due to operations on biliary tract. The common causes for spontaneous internal biliary fistula includes cholelithiasis, peptic ulceration and malignant neoplasm (Shiu) 1967. In a study of 819 cases by Waggoner and Le Mone (1949) 51% of such fistulae were cholecystoduodenal, 21% cholecystocolic, 19% choledocoduodenal, while the rest were choledocogastric and cholecystocholedocal. Most common cause for spontaneous choledocoduodenal fistula is due to gall stones, but, rarely posterior penetrating duodenal ulcer may also cause this condition. The following report concerns a spontaneous biliary fistula of the choledocoduodenal type, due to chronic duodenal ulcer.