title: Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy.
abstract: BACKGROUND
  Bile leak after cholecystectomy which is the frequency less than 2% is an important problem for patients. Some bile duct injuries occuring after laparoscopic cholecystectomy are the complex bile duct injuries and can cause bile leak and fistula.
  
  
  METHODS
  A 74-year-old woman has high output bile drainage from abdominal drain after laparoscopic cholecystectomy so an ERCP was performed. It was clear that there was a complete transaction of bile ducts, however this finding was inconsistent with the patient's clinical situation. The bile drainage of the patient was ceased and she was discharged to home without any problem. Four months later the patient was admitted again for recurrent cholangitis episodes. Patient was operated to perform a biliary-enteric diversion for the suspicion of biliary stricture. There was a thin fistula tract over the duodenum that was previously seperated from the proximal choledochus. The distal part of the bile duct was ended blindly. A hepaticojejunostomy anastomosis over a transhepatic stenting was performed.
  
  
  CONCLUSIONS
  The circumferential injuries are the most common and devastating injuries leading to bile leak, peritonitis and varying degrees of sepsis. The probability of a bile fistula to close spontaneously is almost impossible in cases of iatrogenic circumferential full thickness injuries.
  
  
  CONCLUSIONS
  In the present case we have reported a case of Bismuth type 2 (Strasberg type E2) injury in which the biliary drainage was closed spontaneously with the formation of spontaneous biliary-duodenal fistula. It is an extremely interesting case that has not been reported in the literature previously.
authors.affiliation: Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020, Afyon, Turkey.
authors.forename: Sezgin
authors.initials: S
authors.lastname: Yilmaz
authors.affiliation: Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020, Afyon, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akici
authors.affiliation: Afyon State Hospital, Radiology Clinic, 03020, Afyon, Turkey.
authors.forename: Nazan
authors.initials: N
authors.lastname: Okur
authors.affiliation: Afyon State Hospital, General Surgery Clinic, 03020, Afyon, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Türel
authors.affiliation: Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020, Afyon, Turkey. Electronic address: ogunersen@hotmail.com.
authors.forename: Ogun
authors.initials: O
authors.lastname: Erşen
authors.affiliation: Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020, Afyon, Turkey.
authors.forename: Enes
authors.initials: E
authors.lastname: Şahin
keywords: Bile duct; Cholecystectomy; Duodenum; Fistula; Injury; Laparoscopy