[Is spontaneous, internal bilio-digestive fistula a surgical indication?]

Spontaneous enterobiliary fistulas are recognized preoperatively in only about 50 per cent of patients. Ultrasonography and intravenous cholangiogram merely demonstrate alterations of cholelithiasis. In plain abdominal radiograph biliary gas is presumptive evidence of enterobiliary fistula formation. Barium studies or ERC often succeed in outlining fistula preoperatively. Because of additional findings in more than 70 per cent of cases, such as calculous biliary disease, carcinoma of gallbladder and ascending cholangitis surgical repair of enterobiliary fistula always should be performed. This counts among the most difficult surgical procedures in biliary tract and is burdened with a mortality of 4 to 22 per cent. Experience with 33 patients operated on are reported. In 5 patients enterobiliary fistula was associated with carcinoma of gallbladder, which was discovered in 3 patients only at histopathologic investigation.