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Choledochoduodenal fistula in Mainland China: a review of epidemiology, etiology, diagnosis and management.

Wu MB, Zhang WF, Zhang YL, Mu D, Gong JP - Ann Surg Treat Res (2015)

Bottom Line: Epigastric pain (589 of 728) and cholangitis (395 of 728) were the most common symptoms of CDF.Fistulas between 0.5 cm and 1.0 cm (467 of 654) which were followed frequently by cholangitis attacks also required surgery; the rest were recommended to have stone removal and/or the application of an effective biliary drainage.CDF should be considered in differential diagnosis of recurrent epigastric pain and cholangitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, the Second Hospital of Chongqing New North Zone, Chongqing, China.

ABSTRACT

Purpose: Choledochoduodenal fistula (CDF) is an extremely rare condition even in the most populous nations. However, diagnostic tools are inadequate for the young surgeon to be made aware of such a rare condition before surgery. Hence, basic understanding of the epidemiology, etiology, and management for this unusual but discoverable condition are necessary and essential.

Methods: The exclusive case reports of CDF, which were published from 1983 to 2014 concerning mainland Chinese people, were performed to review the epidemiology, etiology, and management.

Results: A total of 728 cases were incorporated into this review among 48 papers. More than half of the CDF cases were female (416) with an average age of 57.3 years. CDF was usually caused by cholelithiasis (573 of 728). Epigastric pain (589 of 728) and cholangitis (395 of 728) were the most common symptoms of CDF. CDF was usually detected and confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (475 of 728) in Mainland China. The fistulas larger than 1 cm (82 of 654) were recommended for surgical biliary reconstruction. Fistulas between 0.5 cm and 1.0 cm (467 of 654) which were followed frequently by cholangitis attacks also required surgery; the rest were recommended to have stone removal and/or the application of an effective biliary drainage. Fistulas less than 0.5 cm (105 of 654) were usually received conservative therapy.

Conclusion: CDF should be considered in differential diagnosis of recurrent epigastric pain and cholangitis. A possible ERCP should be arranged to investigate carefully. Depending on the size of fistula and clinical presentation, different programs for CDF are indicated, ranging from drug therapy to choledochojejunostomy.

No MeSH data available.


Related in: MedlinePlus

The classification of choledochoduodenal fistula (CDF). (A) The Ikeda's classification. Type I was located on the longitudinal fold of the papilla, while type II was on the posterior wall of the duodenal bulb. (B) The Gong's classification. Type A is an orifice of CDF located more than 2 cm away from the papilla. Type B is an orifice of CDF located less than 2 cm away from papilla. Type C, or perapapillary CDF, is an orifice of CDF located on the papilla fold. 1, duodenum; 2, CBD; 3, pancreatic duct; 4, major duodenal papilla; 5, CDF.
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Figure 2: The classification of choledochoduodenal fistula (CDF). (A) The Ikeda's classification. Type I was located on the longitudinal fold of the papilla, while type II was on the posterior wall of the duodenal bulb. (B) The Gong's classification. Type A is an orifice of CDF located more than 2 cm away from the papilla. Type B is an orifice of CDF located less than 2 cm away from papilla. Type C, or perapapillary CDF, is an orifice of CDF located on the papilla fold. 1, duodenum; 2, CBD; 3, pancreatic duct; 4, major duodenal papilla; 5, CDF.

Mentions: CDF has been categorized by Ikeda and Okada [64] and Gong et al. [2324] separately. According to the location of the fistula, Ikeda divided CDFs into two types. Type I is located on the longitudinal fold of the papilla, while type II is on the posterior wall of the duodenal bulb (Fig. 2A). However, Gong et al [2324] have divided them into three types, the first type is type A, which is an orifice of CDF located more than 2 cm away from the papilla. The second is type B, characterized by an orifice of CDF located less than 2 cm away from the papilla. Lastly, type C, also called PCDF, is an orifice of CDF located on the papilla fold (Fig. 2B). The classification of CDF is important for the diagnosis and treatment in the clinic, and the position of fistula can suggest what the possible cause of CDF is.


Choledochoduodenal fistula in Mainland China: a review of epidemiology, etiology, diagnosis and management.

Wu MB, Zhang WF, Zhang YL, Mu D, Gong JP - Ann Surg Treat Res (2015)

The classification of choledochoduodenal fistula (CDF). (A) The Ikeda's classification. Type I was located on the longitudinal fold of the papilla, while type II was on the posterior wall of the duodenal bulb. (B) The Gong's classification. Type A is an orifice of CDF located more than 2 cm away from the papilla. Type B is an orifice of CDF located less than 2 cm away from papilla. Type C, or perapapillary CDF, is an orifice of CDF located on the papilla fold. 1, duodenum; 2, CBD; 3, pancreatic duct; 4, major duodenal papilla; 5, CDF.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644904&req=5

Figure 2: The classification of choledochoduodenal fistula (CDF). (A) The Ikeda's classification. Type I was located on the longitudinal fold of the papilla, while type II was on the posterior wall of the duodenal bulb. (B) The Gong's classification. Type A is an orifice of CDF located more than 2 cm away from the papilla. Type B is an orifice of CDF located less than 2 cm away from papilla. Type C, or perapapillary CDF, is an orifice of CDF located on the papilla fold. 1, duodenum; 2, CBD; 3, pancreatic duct; 4, major duodenal papilla; 5, CDF.
Mentions: CDF has been categorized by Ikeda and Okada [64] and Gong et al. [2324] separately. According to the location of the fistula, Ikeda divided CDFs into two types. Type I is located on the longitudinal fold of the papilla, while type II is on the posterior wall of the duodenal bulb (Fig. 2A). However, Gong et al [2324] have divided them into three types, the first type is type A, which is an orifice of CDF located more than 2 cm away from the papilla. The second is type B, characterized by an orifice of CDF located less than 2 cm away from the papilla. Lastly, type C, also called PCDF, is an orifice of CDF located on the papilla fold (Fig. 2B). The classification of CDF is important for the diagnosis and treatment in the clinic, and the position of fistula can suggest what the possible cause of CDF is.

Bottom Line: Epigastric pain (589 of 728) and cholangitis (395 of 728) were the most common symptoms of CDF.Fistulas between 0.5 cm and 1.0 cm (467 of 654) which were followed frequently by cholangitis attacks also required surgery; the rest were recommended to have stone removal and/or the application of an effective biliary drainage.CDF should be considered in differential diagnosis of recurrent epigastric pain and cholangitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, the Second Hospital of Chongqing New North Zone, Chongqing, China.

ABSTRACT

Purpose: Choledochoduodenal fistula (CDF) is an extremely rare condition even in the most populous nations. However, diagnostic tools are inadequate for the young surgeon to be made aware of such a rare condition before surgery. Hence, basic understanding of the epidemiology, etiology, and management for this unusual but discoverable condition are necessary and essential.

Methods: The exclusive case reports of CDF, which were published from 1983 to 2014 concerning mainland Chinese people, were performed to review the epidemiology, etiology, and management.

Results: A total of 728 cases were incorporated into this review among 48 papers. More than half of the CDF cases were female (416) with an average age of 57.3 years. CDF was usually caused by cholelithiasis (573 of 728). Epigastric pain (589 of 728) and cholangitis (395 of 728) were the most common symptoms of CDF. CDF was usually detected and confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (475 of 728) in Mainland China. The fistulas larger than 1 cm (82 of 654) were recommended for surgical biliary reconstruction. Fistulas between 0.5 cm and 1.0 cm (467 of 654) which were followed frequently by cholangitis attacks also required surgery; the rest were recommended to have stone removal and/or the application of an effective biliary drainage. Fistulas less than 0.5 cm (105 of 654) were usually received conservative therapy.

Conclusion: CDF should be considered in differential diagnosis of recurrent epigastric pain and cholangitis. A possible ERCP should be arranged to investigate carefully. Depending on the size of fistula and clinical presentation, different programs for CDF are indicated, ranging from drug therapy to choledochojejunostomy.

No MeSH data available.


Related in: MedlinePlus