Duodenal ulcer complicated with stenosis and the formation of the choledochoduodenal fistula

In addition to the usual complications of peptic ulcer like bleeding, perforation, stenosis, and their combinations, hepatoduodenal ligament can be involved in the ulcerative process in some cases of postbulbar ulcer with formation of the choledochoduodenal fistula. The authors provide the case report of successful surgical treatment of a patient with a post-bulbar duodenal ulcer complicated by subcompensated stenosis and penetration into the hepatoduodenal ligament with the formation of choledochoduodenal fistula without dilatation of the common bile duct and mechanical jaundice. The presence of a fistula between the duodenum and hepaticocholedochus was detected by X-ray of the stomach with use of barium sulfate. Combined vagotomy with transverse duodenoplasty, cholecystectomy, and the drainage from the T-tube was chosen as the method of surgery in this case. The authors emphasize the importance of a comprehensive clinical examination of patients suffering from peptic ulcer for a long time due to the possible development of complications from nearby organs, in particular, penetration into the hepatoduodenal ligament with the formation of choledochoduodenal fistula. In the absence of biliary hypertension and extrapapillary localization of scar-ulcerative changes in the duodenum, it is possible to use organ-sparing surgery with vagotomy, cholecystectomy and temporary external drainage of the common bile duct.