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IMAGES IN MEDICINE
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 146-147

Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease


Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy

Correspondence Address:
Massimo Tonolini
Department of Radiology, "Luigi Sacco" University Hospital, Milan
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.110814

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Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF) from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis) and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head) allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.


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