Spontaneous Internal Biliary Fistula

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RECENTLY we had occasion to make the preoperative diagnosis of cholecystocolic fistula and demonstrate this complication of gallbladder disease at operation. The symptoms and roentgen findings were of sufficient diagnostic interest to stimulate this report.

The patient had a history of multiple attacks of acute cholecystitis for many years and apparently developed the cholecystocolic fistula a few weeks before its recognition. The onset of fistula formation was characterized by a period of upper abdominal pain, fever, prostration, and diarrhea. Barium x-ray study of the colon was diagnostic for an internal biliary fistula.

Case Report

A widow, aged 73, was admitted to the Clinic hospital with a presumptive diagnosis of subsiding acute cholecystitis. Twenty-three years previously a clinical diagnosis of chronic cholecystitis had been made because of a history of recurrent attacks of pain in the right upper abdomen radiating into the right scapular region, often accompanied by nausea and vomiting. The gallbladder had been normal on subsequent repeated cholecystograms until one year prior to admission when gallstones were demonstrated for the first time.

Three weeks before hospital admission the patient experienced a recurrent dull ache in the epigastrium which became progressively intense. She developed a fever ranging from 100 to 102 F. which lasted 5 to 6 days, and passed numerous foul green loose stools. The patient entered a community hospital and during the period of observation was unable to tolerate food. There was no jaundice, no acholic stools or dark urine. She was discharged after the fever subsided and. . .



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