Choledochoduodenal fistula in the absence of primary biliary disease is an unusual complication of duodenal ulcer disease. A case seen recently at the Johns Hopkins Hospital is reported and the literature on Choledochoduodenal fistula secondary to penetrating duodenal ulcer is reviewed. Treatment should be individualized according to the clinical situation. The elderly or poor risk patient, in the absence of complications, can be treated with an intensive medical regimen of antacids or cimetidine, or both. Surgical therapy is indicated in patients with a history of intractability or complications of duodenal ulcer disease. Exclusion-type gastrectomy is optimal. An attempt at division of the fistula itself is hazardous and unnecessary since long-term complications are rare.
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