Choledochoduodenal fistula after iatrogenic common bile duct injury treated by Endoscopic Retrograde Cholangiopancreatoscopy (ERCP). Report of two cases

Choledochoduodenal fistula is a rare type of internal biliary fistula most commonly caused by cholelithiasis. Here we report two cases choledochoduodenal fistula created due to common bile duct (CBD) injury during laparoscopic cholecystectomy (LC). During an 8-year period two different patients were referred to our department for post-LC CBD injury, patient A due to bile leak 20 days after LC and B due to repeated episodes of cholangitis one year after LC. Both on admission were haemodynamically stable with increased direct bilirubin, γGT and ALP. CT and MRI/MRCP indicated dilatation of endo-hepatic bile-ducts. MRCP failed to demonstrate the final part of the CBD. Both initially underwent ERCP which was abandoned due to unsuccessful cannulation of the CBD stricture. Afterwards both patients underwent Percutaneous transhepatic cholangiography (PTC) with internal-external drainage. Following PTC, in patient A, duodenoscopy revealed a false route of the catheter through the duodenal bulb and a fully covered metal 6cm stent was placed through the fistulous tract which connected the upper CBD with the bulb. In pt B, a choledochoduodenal fistula originating from the upper CBD and with its orifice, measuring 1-2mm, located in the duodenal bulb was documented and a 4cm long fully covered metal stent was placed through the tract after balloon dilatation of the tract. Eight years and 3 months respectively post treatment patients are asymptomatic with normalisation of liver enzymes. To conclude, iatrogenic choledochoduodenal fistula can be safely and efficaciously treated with application of fully covered metal stents through the fistulous tract.

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Artikel online veröffentlicht:
27. März 2025