A case of choledochogastric fistula accompanying epigastric pain / 대한내과학회지

ABSTRACT

Biliary enteric fistula is fistulous communication between the biliary tract and the gastrointestinal tract due to gallstones, peptic ulcer, malignancy and trauma. The types of fistulas are cholecystoduodenal, cholecystocolonic, choledochoduodenal, cholecystogastric and very rare choledochogastric. The preoperative diagnosis is difficult because their symptoms are usually nonspecific. Pneumobilia on plain film of the abdomen has been considered as a clue. Reflux of contrast media into the biliary tree during a barium study or an endoscopic retrograde cholangiopancreatography is most suggestive finding. We experienced a case of spontaneous choledochogastric fistula. A 62-year-old man was admitted to Chungbuk National University Hospital with epigastric pain. A 5 mm sized orifice of fistula on the prepyloric antrum of the stomach was observed on gastroscopy. Abdominal computed tomography scan showed pneumobilia in the intrahepatic duct of the liver. Upper gastrointestinal series showed the contrast media leaking from the posterior wall of antrum of the stomach into the common bile duct.