PMC4386110_01
A 2.0-cm duodenal ulcer covered by yellowish debris tissue with two openings at the ulcer base.
crg-0009-0068-g01.jpg
PMC4386110_01_crg-0009-0068-g01.jpg
F1
After carefully checking the ulcer, two openings were seen at the ulcer base (fig. 1) with whitish epithelial lining of the larger one, therefore a 0.035-inch guidewire was passed through these two nonsurgical openings (fig. 2) followed by contrast injection.
The guidewire was passed through one of the two openings.
crg-0009-0068-g02.jpg
PMC4386110_01_crg-0009-0068-g02.jpg
F2
After carefully checking the ulcer, two openings were seen at the ulcer base (fig. 1) with whitish epithelial lining of the larger one, therefore a 0.035-inch guidewire was passed through these two nonsurgical openings (fig. 2) followed by contrast injection.
One of the openings was a hepaticoduodenal fistula.
crg-0009-0068-g03.jpg
PMC4386110_01_crg-0009-0068-g03.jpg
F3
The authors found that one of the openings was a choledochoduodenal fistula and the other one a hepaticoduodenal fistula (fig. 3).
A plastic stent (10 Fr, 7 cm) was inserted into the left intrahepatic duct.
crg-0009-0068-g04.jpg
PMC4386110_01_crg-0009-0068-g04.jpg
F4
The obstructive jaundice was due to the obstruction of the openings by food particles and a strictured bile duct at segments II and III, so two plastic stents (10 Fr, 7 cm) were inserted with good bile flow (fig. 4). The patient was followed up a month later.