Spontaneous duodenocutaneous fistula: a rare presentation of perforated duodenal ulcer

TL;DR

A rare case of a spontaneous duodenocutaneous fistula caused by a perforated duodenal ulcer is described, with successful non-surgical management leading to recovery.

Contribution

This case report presents a rare spontaneous duodenocutaneous fistula associated with a perforated duodenal ulcer, previously only reported once in the literature.

Findings

A 52-year-old female with a spontaneous duodenocutaneous fistula was successfully managed with endoscopic interventions and nutritional support.

The fistula closed after three months, and the patient showed improved nutritional status and general condition after two years.

Non-surgical management using a Foley catheter and jejunal tube proved effective in controlling infection and supporting recovery.

Abstract

Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication and reported most often following surgery. To the best of our knowledge, the development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has only been reported once.

A 52-year-old female patient presented at the emergency department with a painful ulcer and erythema on the right abdominal wall. On admission, she was in extremely poor general and nutritional condition. Laboratory analysis revealed inflammation. An empiric antibiotic therapy was initiated; parenteral nutrition, fluid, and electrolyte resuscitation were started. An enterocutaneous fistula was postulated and confirmed by endoscopy identifying a perforated duodenal ulcer. Surgery was not a valuable option and a Foley catheter was inserted through the fistula. During further endoscopic interventions, the Foley catheter was first replaced by a jejunal tube and later by a percutaneous endoscopic gastrostomy with a jejunal limb for enteral nutrition. The fistula output decreased, the local infection was controlled and the nutritional status improved.

Three months later the fistula was closed and the gastrostomy tube was removed. After 2 years the patient was in good general and nutritional condition.

Figures