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THE PROXIMITY OF the posterior wall of the duodenal bulb to the common bile duct makes it surprising that peptic ulcer penetration leading to a fistula between them is such a rarity. Such a fistula, however, comprises only from 3.5% to 6% of internal biliary fistulae in reported series. We have been able to trace reports of only 40 cases in the literature since 1915.
The great majority of reports on choledochoduodenal fistula resulting from peptic ulcer have appeared in surgical journals, with subsequent surgery performed on most of the patients described. The consensus in these reports would indicate that surgical intervention is believed to be the choice procedure for this condition, as it unquestionably is in the far commoner cases of internal biliary fistulae secondary to biliary tract disease. Hutchings et al., for example, after presentation of 6 cases and review of the American literature, state categorically, "Surgical therapy
Isaacson S, Appleby LW, Hamilton EL. Choledochoduodenal Fistula Secondary to Duodenal Peptic Ulcer: Case Report. JAMA. 1962;179(12):969–970. doi:10.1001/jama.1962.03050120000013c
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