[Analysis of 26 cases of internal biliary fistula]

One of the more difficult problems in cholelithiasis surgery is posed by the internal biliary fistula. This lesion is defined as an abnormal communication between the accessory biliary tract (gall bladder or cystic duct) and the gastrointestinal tract or main bile duct. Twenty-six patients with internal biliary fistula were operated on over a 12-year period in the Abdominal Surgery Department of Peking Union Medical Hospital. Right upper quadrant abdominal pain was present in all, but variable in degree and persistence. Most of the patients had jaundice, fever and chills. No particular clinical picture is associated with cholelithiasis, and preoperative diagnosis is rare. When internal biliary fistula is diagnosed, the patient should be advised to accept the operation. At operation, adhesions were strikingly dense. In order to protect the main bile duct from injury, it is sometimes necessary to open the gall bladder, then extract stones and perform cholangiography to assess the situation.