The abnormal connection formed between the duodenum and another organ or the skin is a duodenal fistula. There are numerous predisposing factors including history of abdominal or aortic surgery, malignancy or radiation therapy. The diagnosis is determined by the patient's clinical history, physical exam, and a workup that includes laboratory tests and imaging.
The abnormal passage between two organs, or between an organ and the skin is referred to as a fistula which may form between the gastrointestinal tract and other organs in the abdominal cavity or chest or body surface. Specifically, the duodenum can form a connection with the aorta , colon , biliary structures , etc.
Intestinal fistulas are associated with risk factors such as Crohn disease or ulcerative colitis, radiation, previous abdominal or aortic surgery, gynecologic or pancreatic cancer, abdominal trauma, perforation of duodenal ulcers, or appendicitis. Moreover, a majority of fistulas of the small intestine are a consequence of abdominal surgery.
A colo-duodenal fistula manifests as a rare complication of cancer and inflammatory bowel disease (IBD)  and presents with symptoms such as chronic diarrhea, emesis, nausea, abdominal pain, malaise, and significant weight loss  .
An aorto-duodenal fistula (ADF) forms in the context of the close proximity of the duodenum to the abdominal aorta . The clinical presentation in a minority of cases is characterized by the triad of abdominal pain, upper gastrointestinal hemorrhage, and palpable abdominal mass  . Other symptoms may include fever, melena, back pain, etc .
Life-threatening sequelae include malnutrition, electrolyte and fluid abnormalities, abdominal abscess, peritonitis, pancreatitis, sepsis, and others  . Therefore, duodenal fistulas are associated with high mortality .
General appearance characterized by wasting due to weight loss . There may be remarkable abdominal exam findings as well.
Entire Body System
Case 1: A 55-year-old male presented with epigastric burning pain relieved with meals and of duration 5 years.; There was no history of right upper quadrant pain or of fever. An upper GI endoscopy revealed a deformed duodenal cap. [jpgmonline.com]
No mass lesions or lymphadenopathy seen on CAT scan of the abdomen. EGD exam revealed gastritis without any ulcerations and the fistulous site could not be identified. At laparatomy, the gall bladder and cholecysto-duodenal fistula were excised. [nature.com]
Lymphadenopathy per se on CT scanning, when related to a colonic primary, does not necessarily mean they are involved. Some reports suggest the sensitivity for detection of malignant lymphadenopathy is only about 45% in colonic cancer [ 35 ]. [wjso.biomedcentral.com]
We demonstrated, for the first time, the efficacy of over the scope clips (OTSC ) in the treatment of postoperative duodenal fistulas not responding to surgical and medical treatment in high risk patient. [ncbi.nlm.nih.gov]
Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips. Gastrointest Endosc. 2008 ;68: 993 - 996. [journals.sagepub.com]
Abstract Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. [ncbi.nlm.nih.gov]
Other symptoms may include fever, melena, back pain, etc. A choledochoduodenal fistula is uncommon and usually associated with peptic ulcer perforation. Hence, the symptomology reflects that of peptic ulcer disease (eg. dyspepsia). [symptoma.com]
He was on ibuprofen 400 mg bid prn for his arthritis. He denied anorexia or weight loss. His physical exam was unremarkable. His laboratory data were normal. Hepatitis-C antibody was positive. H.pylori serology was negative. [nature.com]
INTRODUCTION: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. [ncbi.nlm.nih.gov]
Julio Galindo, Francisca García-Moreno, Gloria Rodríguez, Pedro Carda, Eduardo Lobo, Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared [reed.es]
Due to her existing anatomy, the patient's desire for continued weight loss and fear that her diabetes, previously cured by gastric banding, would recur, she was converted to RYGB. [journalofmas.com]
One of the most feared complications is perforation. Perforation management depends on the location, radiologic imaging findings, and severity of the injury. [wjgnet.com]
While placing the scope in a short scope position, the scope was rapidly withdrawn into the pylorus and an approximately 10 mm linear perforation occurred in the lateral wall of the duodenal bulb. [wjgnet.com]
Silastic sump placement under the small bowel mesentery and near the duodenum generally permits good drainage; the sumps may be gradually withdrawn later after tube checks and CT scans demonstrate healing. [sites.google.com]
[…] fistula output is not decreased within 48 hours of treatment with somatostatin-14 or octreotide, then treatment should be discontinued. 68 A positive effect on fluid balance charts should also be seen in trials of octreotide, otherwise treatment is withdrawn [gut.bmj.com]
A complete blood count (CBC) is important to assess for anemia and leukocytosis, especially in patients with bleeding, malignancy, and/or chronic disease. Additionally, to investigate the nutritional and metabolic status, a complete metabolic panel (CMP) including levels of electrolytes, albumin, pre-albumin, creatinine, and blood urea nitrogen (BUN) should be obtained. Microbiology studies such as abscess culture are another important components.
A colo-duodenal fistula is effectively outlined by a barium enema  . Furthermore, the conjunctive use of radiology and endoscopy very likely delineates the site and cause of this type of fistula . Also, computed tomography (CT) of the abdomen and pelvis is the imaging test of choice in patients with Crohn disease suspected to have a fistula. This test reveals details about the etiology and involvement of underlying structures.
A biliary-enteric fistula may be initially discovered on CT, ultrasonography, or roentgenogram as reflected by the presence of air in the biliary tree  .
There are other imaging modalities that can identify duodenal fistulas and other related pathologies. For example, ultrasonography reveals the presence of abscesses and fluid in the fistula tract while endoscopy or colonoscopy assesses causes such as IBD or malignancy and allows for biopsy samples. Magnetic resonance imaging (MRI), although not used routinely for enteric fistulas, can diagnose the fistula and its connection to nearby structures. Finally, fistulography demonstrates the relationship of the fistula to the bowel; however, this is an uncommon test.
Viral Inclusion Body
The background pancreatic parenchyma displayed edema, lymphocytic infiltration, and viral inclusion bodies, findings consistent with CMV pancreatitis (Figure 1E, F). [oatext.com]
Edema and marked lymphocytic infiltration were observed (H&E; x100). F. Some epithelial cells had cytomegalic viral inclusion bodies (H&E; x200). G. [oatext.com]
In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases). [ncbi.nlm.nih.gov]
In evaluating and comparing our observation we discuss their significance for topographical associations and prognosis and as an indication for surgical intervention. [ncbi.nlm.nih.gov]
Treatment and prognosis According to several papers, laparoscopic cholecystectomy is often successfully performed in these cases 4-5. gut fistulation Promoted articles (advertising) [radiopaedia.org]
The prognosis of patients treated medically is good, although the fistula can remain asymptomatic. Angiocholitis and biliary sequelae remain rare and do not warrant prophylactic surgical treatment. [panafrican-med-journal.com]
Early diagnosis and treatment can improve the prognosis, but a high index of clinical suspicion is required. [elsevier.es]
The possible etiologic factors in this case are discussed. We believe that this complication will continue to be rare, but health care providers should be aware of its presentation and its preferred method of evaluation and management. [ncbi.nlm.nih.gov]
This test reveals details about the etiology and involvement of underlying structures. [symptoma.com]
This case is unique in that the fistula formed as a result of a complex atherosclerotic abdominal aorta and a localized necrotizing granulomatous aortitis the etiology of which was not clear. [lmaleidykla.lt]
The management depends essentially on the etiology of the fistula. Treatment of CDF caused by duodenal peptic ulcer is controversial. [panafrican-med-journal.com]
Choledochoduodenal fistula in Mainland China: a review of epidemiology, etiology, diagnosis and management. Annals of surgical treatment and research. 2015; 89(5): 240-246. Google Scholar Fedidat R et al. [panafrican-med-journal.com]
AETIOLOGY AND INCIDENCE The aetiology, epidemiology, and classification of gastrointestinal fistulae are complex. [gut.bmj.com]
Thus, in essence, the pathophysiology underlying the development of metabolic acidosis from a duodenal fistula is the same as that of a pancreatic fistula- it is basically the same secretions being lost. Not so for the jejunum. [derangedphysiology.com]
The definite cause or pathophysiology is not in clear yet and, in most cases, multiple factors are thought to be associated. [kjim.org]
Several pathophysiological theories are put forth. [ispub.com]
Understanding the pathophysiology of, as well as the risk factors for, ECFs should help to reduce their occurrence. [emedicine.medscape.com]
Berry SM, Fischer JE, Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 1996 ; 76 : 1009 –18. Donner CS. Pathophysiology and therapy of chronic radiation-induced injury to the colon. Dig Dis 1998 ; 16 : 253 –61. [gut.bmj.com]
Biliary enteric fistulas have been known to result in adenocarcinoma hence the recommendations to excise it as a preventive measure. [nature.com]
A healthy, unbroken digestive system also prevents the non-sterile food from entering the body, and the duodenal fistula can expose bodily tissues to pathogens, thus resulting in infections. [wisegeek.com]
Operative therapy Prevention Because most fistulas follow surgical mishaps, the foremost principle in management is prevention. [surgwiki.com]
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