Internal biliary fistula due to cholelithiasis: a single-centre experience.
OBJECTIVE
To discuss about the perioperative problems encountered in patients with internal biliary fistula (IBF) caused by cholelithiasis.


METHODS
In our hospital, 4,130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.


RESULTS
The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 13 d. Two wound infections, three bile leakages and three mortalities were observed.


CONCLUSIONS
Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.
Duzgun
Arife Polat
AP
Department of 3rd Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Ozmen
Mehmet Mahir
MM
Ozer
Mehmet Vasfi
MV
Coskun
Faruk
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D001658:Biliary Fistula / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects; D002769:Cholelithiasis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome