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Spontaneous Biliary-Enteric Fistulas and Associated Complications: An Overview.

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    Spontaneous biliary-enteric fistulas (SBEF) are abnormal connections between the bile duct and intestines, often caused by gallstones. Gallstone ileus is a key complication, requiring prompt diagnosis and treatment, often surgically.

    Keywords:
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    Area of Science:

    • Gastroenterology
    • Hepatology
    • Surgical Pathology

    Background:

    • Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and gastrointestinal tract, typically caused by biliary or gastrointestinal disease.
    • Chronic recurrent cholelithiasis (gallstones) accounts for nearly 90% of SBEF cases, with penetrating peptic ulcers and neoplastic infiltration being less common etiologies.
    • Cholecystoduodenal fistula is the most frequent type of SBEF, while choledochoduodenal fistula is the least common.

    Purpose of the Study:

    • To review the etiology, complications, diagnosis, and management of spontaneous biliary-enteric fistulas.
    • To highlight gallstone ileus as a significant, often delayed-diagnosis complication of SBEF.
    • To discuss diagnostic modalities and surgical approaches for SBEF and its complications.

    Main Methods:

    • Literature review of spontaneous biliary-enteric fistulas and their complications.
    • Analysis of diagnostic criteria, including radiological signs like Rigler's triad/tetrad.
    • Examination of surgical management options, including enterolithotomy and radical treatment.

    Main Results:

    • Gallstone ileus, a rare complication of biliary lithiasis, is the most significant complication of SBEF, causing mechanical intestinal obstruction.
    • Gallstone ileus affects hospitalized patients at a rate of 0.000015% and surgical patients at 0.0003%, predominantly women over 65.
    • Diagnostic hallmarks include Rigler's triad/tetrad on imaging, with contrast-enhanced CT being the gold standard; laparoscopy is increasingly used for surgical management.

    Conclusions:

    • SBEF and its complications, particularly gallstone ileus, are often underrecognized, leading to diagnostic and treatment delays.
    • Prompt diagnosis using advanced imaging and appropriate surgical intervention are crucial for managing SBEF and preventing severe complications.
    • Management strategies range from simple enterolithotomy for high-risk patients to radical procedures for favorable cases, with laparoscopic approaches gaining prominence.