title: New strategy to prevent ascending cholangitis in larger choledochoduodenal fistula.
abstract: BACKGROUND
  Choledochoduodenal fistula (CDF) is a complication of common bile duct stones or cholangitis in Asia. It is unclear as to which type of the fistula needs surgical treatment.
  
  
  METHODS
  To determine whether the sizes of CDF imply different clinical presentations and treatments, we reviewed 50 patients with CDF and their treatments during a recent 14-year period. For treatments of CDF, we applied the conventional methods, including removal of stone and complete decompression of biliary obstruction to treat the original bile lesions. In addition, according to the sizes of fistula and the frequencies of ascending cholangitis, we proposed the following strategies for fistula treatments: (i) for fistula orifices larger than 1 cm, a transection of common bile duct was applied to prevent the reflux of duodenal juice; (ii) for fistula orifices between 0.5 and 1.0 cm, an effective biliary drainage was applied; and (iii) for fistula orifices less than 0.5 cm, non-surgical treatments were applied.
  
  
  RESULTS
  We found that hepatic biliary duct stones and hepatic biliary duct strictures were associated with more severe cholangitis (P = 0.037 and P = 0.009, respectively), but not with the episodes of cholangitis (P = 0.654 and P = 0.664, respectively). In contrast, the sizes of fistula >1 cm were associated with more frequent episodes of cholangitis (r = 0.774; P < 0.001).
  
  
  CONCLUSIONS
  The larger fistula increases frequency of cholangitis episodes and needs surgical treatment for fistula itself.
authors.affiliation: Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Zhi-Hua
authors.initials: ZH
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Ding
authors.forename: Yongqian
authors.initials: Y
authors.lastname: Ye
authors.forename: Lei
authors.initials: L
authors.lastname: Cai
authors.forename: Xiangde
authors.initials: X
authors.lastname: Liu
authors.forename: Jikui
authors.initials: J
authors.lastname: Liu
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Li
authors.forename: Jiahong
authors.initials: J
authors.lastname: Dong
mesh_terms: D001649:Bile Duct Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001658:Biliary Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D002761:Cholangitis / Q000150:complications / Q000517:prevention & control*; D004378:Duodenal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged