Spontaneous internal biliary fistulas

Abstract

Author(s): Bode Rovena, Dracini Xheladin, Celiku Etmond

Introduction: Internal spontaneous biliary fistulas, or abnormal communications between the gallbladder or biliary ductal system and internal organs of the body, occur secondary to pathologic processes that involve the gallbladder, bile ducts, stomach, duodenum, small intestine, and colon. Their clinical manifestations are produced by local effects of abnormal communication with the adjacent bowel. The chronically diseased and obstructed biliary tract is exposed to contamination by intestinal content and the resulting symptoms are biliary in character. When a calculus has sufficient size to occlude the lumen of the bowel, it passes into the intestinal tract, and findings are primarily those of bowel obstruction. Aim of the study: The purpose of this study is to evaluate the clinical features and surgical management of spontaneous internal biliary fistulas, found in patients who had not previously had surgical procedures on or near the biliary tract. We reviewed a number of consecutive patients who had been treated for biliary tract diseases during a 4-year period (June 2013-July 2017). Results: Jaundice was a usual sign of spontaneous internal biliary fistulas, found in all patients. Severe inflammation of the extrahepatic biliary system was present in most cases, resulted from contamination by intestinal content. All of cases were discovered during operation, no one diagnosed preoperatively. Conclusion: Surgeons must be aware of the possible presence of an internal biliary fistula before surgical intervention, for adopting appropriate imaging modalities before surgery. This might be particularly true when considering laparoscopic cholecystectomy. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially for elderly patients with cholelithiasis.

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