Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report - PubMed (original) (raw)

Case Reports

Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report

Jamal Akhavan Moghaddam et al. BMC Gastroenterol. 2006.

Abstract

Background: The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding.

Case presentation: We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars) in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation) illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar.

Conclusion: Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.

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Figures

Figure 1

Figure 1

Obstructing materials. Bezoar material in the shape of a CBD cast (solid arrow) and multiple stones (open arrow) removed from the dilated common bile duct by surgery.

Figure 2

Figure 2

The post-operative T- tube cholangiography. It is demonstrating a fistula (open black arrow) located between the CBD (solid arrow) and the duodenum (open white arrow).

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