title: Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report.
abstract: BACKGROUND
  The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding.
  
  
  METHODS
  We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars) in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation) illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar.
  
  
  CONCLUSIONS
  Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.
authors.affiliation: Department of General Surgery, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Mollasadra Street, Tehran, Iran. Akhavan_j@yahoo.com
authors.forename: Jamal Akhavan
authors.initials: JA
authors.lastname: Moghaddam
authors.forename: Mohsen
authors.initials: M
authors.lastname: Amini
authors.forename: Soheil
authors.initials: S
authors.lastname: Adibnejad
mesh_terms: D001630:Bezoars / Q000209:etiology*; D001652:Bile Ducts; D001658:Biliary Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D004378:Duodenal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D041781:Jaundice, Obstructive / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications