گزارش يك مورد بروز بزوار در مجراي صفراي بعد از انجام كله ستيكومي به علت تشكيل فيستول بين كلدوك و دوازدهه

Development of Bile Duct Bezoar after Cholecystectomy Caused by Choledochoduodenal Fistula Formation - A Case Report of an Extremely Rare Event.

Introduction & Objective: The formation of bile duct bezoar is a rare event, and when it occurs without previous history of choledochoenteric anastomosis, or duodenal diverticulum, it constitutes an extremely scarce finding with almost no reported case in literature. Materials & Methods: We report a recent experience with obstructive jaundice following a bezoar development in the common bile duct caused by choledochoduodenal fistula development. Results: A 60-year-old female, 6 years after cholecystectomy, was presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated multiple stones in the biliary tract. Because of the size of stones, the patient underwent an operation, and the stones were retrieved. The histological assessment of the stones revealed fibrinoid materials with some cellular debris. Postoperative T-tube cholangiography illustrated an open bile duct without any sign of stone. Surprisingly, a relatively long choledochoduodenal fistula was detected. In fact, it was assumed that the fistula formation led to the bile duct bezoar development. Conclusions: In final analysis, it is concluded that bezoar formation within bile duct should be taken into consideration as a differential diagnosis which can alter our treatment modality from surgery to more intra-ERCP efforts.