Diagnosis And Treatment Of Choledochoduodenal Fistula: Five Cases Reports And Literature Review

Objective:Cholecystoduodenal fistula is the highest complications of gallbladder internal fistula.It has an abnormal channel between the gallbladder and duodenum.Recent advances in hepatobiliary imaging techniques has led to the increased detection of gallbladder internal fistula.However,the diagnosis and treatment of cholecystoduodenal fistula is still a challenge.In this study,we analyzed and summarized the experience of the diagnosis and treatment of cholecystoduodenal fistula in our patients.it could provide the treantment basis for the clinical doctors.Methods:Five patients patients with cholecystoduodenal fistula were diagnoses and treated in our department from march 2000 to march 2014.According to the situation of the patients,to explore the factors which could lead to a preoperative diagnosis and to guide the management of cholecystoduodenal fistula.Results:There is no specificity clinical manifestations of five patients.its past history of biliary disease,upper abdominal pain,fever,and jaundice may be lead to cholecystoduodenal fistula.All patients were found in the process of operation.It were four open surgerys and one laparoscopic surgery.Four cases were well recovered after the surgery,no acute complications and treatment related damages occurred in four cases.One patient was died of asperger syndrome after operation.Conclusions Because there was no characteristics of clinical manifestation in cholecystoduodenal fistula,so preoperative diagosis is very difficult.Doctors should pay more attentions to the disease,Medical history of patients with acute abdomen may be detailed,so appropriate checks should be made to confirm or rule out the diseases.It can improve the correct rate of disease preoperative that operation has been effective with fair prognosis.Depending on the type of procedure,patients may leave the hospotal in few days and return to normal activities more quickly than patients recovering from open surgery.But if the acute inflammation has no control with laparoscopic surgery,it would bring more serious and emergence complications.Operative rherapy,including laparoscopic surgery,was the primary treatment for most patients,regardless of the preoperative diagnosis.