CHOLEDOCHODUODENAL FISTULA DUE TO PEPTIC-ULCER - A REVIEW OF 4 CASES

Four cases of choledochoduodenal fistula due to peptic ulcers were see n among 850 patients who had surgery for a duodenal ulcer between 1980 and 1996. The fistula was well tolerated in every case despite massiv e reflux into the bile duct on the upper gastrointestinal tract study. Three patients were treated by truncal vagotomy with a gastrojejunost omy and had a functional outcome stage I or II according to Visick aft er a follow-up of six months to three years. The remaining patient had subtotal gastrectomy and subsequently developed a duodenal fistula, A s compared to the other surgical procedures used in duodenal ulcers, v agotomy with gastrojejunostomy is simple, avoids the hazards of dissec tion near the ulcerated area, and ensures complete healing of the ulce r and, if present, of the bile duct fistula.