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Internal biliary fistula due to cholelithiasis: a single-centre experience
Arife Polat Duzgun1, Mehmet Mahir Ozmen, Mehmet Vasfi Ozer
1Department of 3rd Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Insights
Internal biliary fistula (IBF) is a rare complication of cholelithiasis, occurring in 0.3% of cases. Early cholecystectomy is recommended to prevent IBF and associated perioperative issues.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Cholelithiasis (gallstones) can lead to rare but serious complications.
- Internal biliary fistula (IBF) is an abnormal connection between the biliary tree and other organs, often caused by gallstones.
Purpose of the Study:
- To analyze the perioperative challenges and outcomes in patients with internal biliary fistula (IBF) secondary to cholelithiasis.
- To highlight the incidence and clinical presentation of IBF in patients undergoing cholecystectomy.
Main Methods:
- Retrospective analysis of 12 patients diagnosed with IBF out of 4,130 cholecystectomies for symptomatic cholelithiasis (2000-2004).
- Data reviewed included patient demographics, clinical presentation, surgical approach, fistula type, and postoperative complications.
Main Results:
- IBF incidence was 0.3%; mean patient age was 57 years.
- Most patients had non-specific symptoms; IBF was suspected preoperatively in only two cases.
- Common fistula types were cholecystoduodenal (10 patients) and cholecystocholedochal (2 patients), with a 25% mortality rate (3/12).
Conclusions:
- Early cholecystectomy for cholelithiasis is crucial to prevent complications like IBF.
- Surgeons should maintain a high suspicion for IBF, especially during difficult dissections, to avoid iatrogenic injuries.
Aim:
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.
Conclusion:
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.
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