Choledochoduodenal fistula: an unusual complication of penetrated duodenal ulcer disease

Spontaneous choledochoduodenal fistula in the absence of primary biliary disease is a very unusual complication of duodenal ulcer disease. In most cases it is diagnosed incidentally, because it seldom gives clinical manifestations. Although surgical approaches have been the treatment of choice in the past, the use of modern antisecretory drugs turns now management strategy to more controversial issues, as the fistula per se is not an indication for surgery.