Less commonly they may lead to cholangitis, duodenal stenosis or duodenal fistula
. [7,8] On occasion hydatid cysts in the pancreatic head may remain silent, but be palpable as an epigastric mass lesion.
CT scan with positive oral contrast media revealed free fluid and air in the peritoneal cavity and contrast media leakage through the surgical drain due to a duodenal fistula
. Another surgical operation was performed to repair the AEF.
Percutaneous obliteration of duodenal fistula
. J R Coll Surg Tdinb 2000; 45:342-4.
The aim is to convert a potentially uncontrolled lateral duodenal fistula
into a controlled end-fistula by diversion of gastric and biliary contents away from the duodenal injury, while making provision for early enteral nutrition via a gastrojejunostomy.
In literature, a case was described wherein a biliary leakage secondary to the duodenal fistula
was treated with the VAC system (6).
It is believed that 75%-85% of duodenum injury could be closed primarily and the incidence of duodenal fistula
is less than 10%.
In the fistuloclysis group, patients were further divided into three subgroups according to the EF locations: Group 1, patients with jejunal-ileal fistula (n = 11); Group 2, patients with biliary fistula (n = 16); Group 3, patients with duodenal fistula
(n = 8).
The fourth patient with multiple gun-shots to the abdomen developed duodenal fistula
after two weeks and died due to multi-organ failure on 23d day after the first surgery.
CT abdomen showed features of chronic cholecystitis, cholecysto duodenal fistula
with gall stone ileus due to large impacted stone in terminal ileum.
Thirteen days after the initial repair he developed a high-output duodenal fistula
which drained 5 000-7 000 ml per day.
Operation is not always compulsory in patients with an isolated duodenal fistula
, due to most of them being asymptomatic.
Cholecystectomy was performed and the duodenal fistula