Internal Biliary Fistula

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INTERNAL biliary fistula is an abnormal communication between a portion of the extrahepatic bilary tract and any other viscus. The fistula may result from trauma, inflammatory disease, calculi, or malignant disease of the biliary tree per se, or from traumatic, inflammatory or neoplastic disease of adjacent organs.

Our study is based on the findings in 18 patients who had internal biliary fistulas; one case of spontaneous cholecystocolic fistula is included which previously had been reported by Michels and Hoerr.1


Although internal biliary fistula is an uncommon complication of chronic cholecystitis and cholelithiasis, the incidence of the lesion frequently is underestimated. In one large series2 of patients undergoing biliary surgery at the Mayo Clinic, the incidence of internal biliary fistulas was 0.86 per ccnt, while in a somewhat smaller recent series here, the incidence was 0.5 per cent.

The sex ratio in the 18 patients of this report, 13 women and 5 men, approximates that which generally has been reported for the condition, and is comparable to the sex ratio for patients having cholelithiasis. The range of ages was 43 to 72 years, with an average of 57.6 years (Table 1).

In the order of their frequency, the most common of the internal biliary fistulas are the cholecystoduodenal, cholecystocolic, and choledochoduodenal. Waggoner and LeMone,3 who summarized 819 reported cases of internal biliary fistulas, found that 50 per cent were of the cholecystoduodenal type, 21 per cent of the cholecystocolic, 19 per cent of the choledochoduodenal, and 9 per cent of. . .



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