Choledoduodenal Fistula following the Treatment of a Liver Inflammatory Pseudotumor with IgG4-Related Sclerosing Cholangitis—A Case Report—

Abstract

A 77-year-old man was diagnosed with intrahepatic cholangiocarcinoma with portal vein invasion, and underwent left hepatectomy. The pathological diagnosis was liver inflammatory pseudotumor with IgG4-related sclerosing cholangitis (IgG4-SC). No other organ IgG4-related disease or residual disease was observed. The patient was followed up without steroids. Six months later, he was admitted with upper abdominal pain and jaundice. Abdominal computed tomography revealed dilation of the right bile duct and tissue thickening around the bile duct, suggesting fistula formation with the posterior wall of the duodenal bulb. Upper gastrointestinal endoscopy revealed a deep ulcer on the posterior wall of the duodenal bulb. A diagnosis of choledoduodenal fistula due to the recurrence of IgG4-SC and duodenal ulcer was made. Following steroid therapy, the abdominal pain and jaundice disappeared, and tissue thickening around the bile duct improved.