Multiple choledochoduodenal fistulas in the periampullary region

Five patients with two periampullary choledochoduodenal fistulas diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) are described. In two patients both fistulas were on the oral prominence of the papilla, whereas in the remaining three, one of the two fistulas was more proximal. All five patients presented with right upper abdominal pain, which was associated with chills, fever and jaundice in two. ERCP revealed choledocholithiasis in two patients, cholecystolithiasis in one, hepatocholedocholithiasis in one, and bile duct dilatation without stone in one. A previous history of pain episodes accompanied by jaundice was obtained in four cases, and surgical bougienage of the papilla had been performed during previous common bile duct exploration in two, which may be responsible for the occurrence of multiple fistulas by possible false passage.