To the Editor.—Most spontaneous internal biliary fistulas are caused by gallstones eroding into surrounding hollow viscera. Cholecystoduodenal fistulas are most common followed by cholecystocolic, choledochoduodenal, and cholecystogastric fistulas.1,2
Rarely, a choledochoduodenal fistula may be due to benign ulcer disease. Such a patient is described below.
Report of a Case.—A 41-year-old man (a taxi driver) with a 20-year history of duodenal ulcer was admitted to the hospital. An upper gastrointestinal tract series demonstrated free reflux of barium into the biliary tree. Gastroduodenoscopy disclosed a duodenal ulcer located at the posterior wall of the duodenum.
A subtotal gastrectomy and gastrojejunostomy were performed. The gallbladder and the common bile duct seemed distended. Exploration of the bile ducts and perioperative cholangiography showed no stones or stenosis, but the contrast material did not enter the duodenum and the fistulous tract was not demonstrated.
The obstruction of the ampulla of Vater was explained