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August 1986

External Duodenal Fistula: Causes, Complications, and Treatment

Author Affiliations

From the Department of Surgery, The Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey. Drs Rege and Joehl are now with Northwestern University Medical School, Chicago.

Arch Surg. 1986;121(8):908-912. doi:10.1001/archsurg.1986.01400080050009

• We reviewed records of 18 patients with external duodenal fistula. Fourteen patients developed duodenal fistulas following an operation, two following abdominal trauma, and two as a complication of other diseases. Copious drainage of intestinal juice from the abdomen was the most common presenting sign. Contrast fistulography, upper gastrointestinal tract roentgenography, and T-tube cholangiography were useful diagnostic studies. Nine patients were treated nonoperatively; nine patients required at least one operation. Complications occurred frequently; of special interest were three patients who developed postoperative acute cholecystitis. Six patients died (33% mortality). Factors associated with mortality were advanced age (65 years), uncontrolled infection and multiple organ failure, high-output fistula, malnutrition, delay in diagnosis (more than three days), and multiple reoperations to treat the fistula or complications. External duodenal fistula continues to be a life-threatening problem whether it is postoperative, posttraumatic, or secondary to a disease process.

(Arch Surg 1986;121:908-912)

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