title: External duodenal fistula. Causes, complications, and treatment.
abstract: 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 (greater than 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.
mesh_terms: D000007:Abdominal Injuries / Q000150:complications; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D004322:Drainage; D004378:Duodenal Diseases / Q000150:complications / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000209:etiology* / Q000628:therapy; D007419:Intestinal Secretions; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications