Summary
In 2,012 ERCP studies reviewed in the period between 1976 and 1989, we observed 14
choledochoduodenal fistulas found in the upper portion of the papilla of Vater. Two
fistulas occurred spontaneously due to necrosis of the duodenal wall caused by stones
located in the distal common bile duct above the sphincter of the papilla. In these
two cases the stones were removed endoscopically. The twelve remaining cases were
iatrogenic, caused during surgical papillotomy which resulted in a false tract. All
patients showed raised AP and γGT. Eight had acute cholangitis. 7 were jaundiced,
there was one case each of acute pancreatitis and chronic recurrent pancreatitis.
Nine patients had stones located in the distal common bile duct. In eight cases it
was possible to cannulate the papillary opening and do a papillotomy thereby connecting
the fistulous orifice with the opening of the papilla. The other patient was treated
surgically. Two patients had papillary stenosis. One was successfully treated with
papillotomy through the papillary opening. In the other, the fistulous orifice was
joined with the papillary opening using a diathermy scalpel. This patient suffered
a posterior duodenal wall perforation. One patient with acute pancreatitis and common
bile duct stones distal to the fistula improved with papillotomy and stone removal.
The patient with chronic recurrent pancreatitis without lithiasis refused any form
of treatment.
Key words:
Biliarysystem - Fistulas - ERCP - Endoscopy - Therapy
