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Case Reports
. 2016 Nov 4;11(4):309-312.
doi: 10.1016/j.radcr.2016.08.018. eCollection 2016 Dec.

Choledochoduodenal fistula in the setting of Crohn's disease

Shane Knipping  1 , Ravi Rajpoot  1 , Roozbeh Houshyar  1
Affiliations
Case Reports

Choledochoduodenal fistula in the setting of Crohn's disease

Shane Knipping et al. Radiol Case Rep. .

Abstract

Of all the spontaneous fistulas that occur between the extrahepatic biliary system and the intestine, a choledochoduodenal fistula is rarely seen. When it does occur, it is most often secondary to a perforated duodenal ulcer, choledocholithiasis, or cholelithiasis. It may also be seen following complications related to iatrogenic injury or tuberculosis. Generally, choledochoduodenal fistulas are asymptomatic, but may present with vague abdominal pain, fever, and other symptoms related to cholangitis. As a result, they can be difficult to diagnose clinically before imaging is obtained. We present a case of a 74 year old, asymptomatic, female with a past medical history significant for Crohn's disease who was found to have a choledochoduodenal fistula demonstrated on MRCP, possibly secondary to her underlying inflammatory bowel disease.

Keywords: Bilioenteric fistula; Choledochoduodenal fistula; Crohn's disease.

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Figures

Fig. 1
Fig. 1
Coronal true fast imaging with steady-state free precession (TRUFI) sequence demonstrating a long segment of distal ileum with wall stratification and thickening (arrows).
Fig. 2
Fig. 2
T1-weighted postcontrast (coronal) sequence demonstrating hyperemia (arrow) in the same segment of distal ileum signifying acute on chronic disease.
Fig. 3
Fig. 3
MRCP detailing the biliary tree (right hepatic duct [R], left hepatic duct [L], and common bile duct [CBD]) with fistulous connection (F) between the CBD and duodenum (D).
Fig. 4
Fig. 4
T1-weighted in-phase (axial) sequence showing pneumobilia (arrows).
Fig. 5
Fig. 5
T2 sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) maximal intensity projection (MIP) coronal image detailing the biliary tree with fistulous connection (F) between the common bile duct (CBD) and the duodenum (D).
See this image and copyright information in PMC

References

    1. Jordan P., Stirrett L. Treatment of spontaneous internal biliary fistula caused by duodenal ulcer. Am J Surg. 1956;91(3):307–313. - PubMed
    1. Page J., Dow J., Dundas D. Ulcerogenic choledochoduodenal fistula. Clin Radiol. 1989;40(1):58–60. - PubMed
    1. Hoppenstein J., Medoza C., Watne A. Choledochoduodenal fistula due to perforating duodenal ulcer disease. Ann Surg. 1971;173(1):145–147. - PMC - PubMed
    1. Leblanc K., Barr L., Rush B. Spontaneous biliary enteric fistulas. South Med J. 1983;76(10):1249–1252. - PubMed
    1. Aziz M., Ahmed M., Siddiqui M., Shipa M., Sarker S., Arif S. Choledochoduodenal fistula secondary to duodenal ulcer disease and choledocholithiasis: report of 2 cases. J Armed Forces Med Coll, Bangladesh. 2008;4(2):38–41.

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