Duodenal ulcer with choledochoduodenal fistula presenting acutely with free perforation into the peritoneal cavity

BACKGROUND: Choledochoduodenal fistulae are rare and are usually diagnosed incidentally on the investigation for upper gastrointestinal symptoms. It is unusual for them to present as an emergency with free perforation into the peritoneal cavity. METHOD: Case report. RESULTS: Described below is a case report of a 68-year-old man who, after a short history of epigastric pain, presented as an emergency with the symptoms and signs of peritonitis and was found at laparotomy to have a perforated duodenal ulcer eroding into the common bile duct with free bile leakage. The operative procedure performed fulfilled the criterion for the surgical management of choledochoduodenal fistulae described by Hutchins nearly half a century ago i.e. to achieve ulcer healing and allow biliary drainage while preventing biliary reflux. CONCLUSIONS: This case report draws the readers' attention to this unusual complication of a rare condition, which nonetheless can be an unsuspected finding at laparotomy for a perforated duodenal ulcer.