[Internal biliary fistula of lithiasic origin]

The authors present 17 cases of patients with internal biliary fistulae of lithiasic origin. Nine of these were of the cholecystoduodenal type, 2 of the cholecysto-gastric type, 2 had developed between the cholecyst and the colon, and 4 were of the bilio-biliary type, between the cholecyst and the choledochus. These cases represented 1.1% of the 1,500 interventions carried out on the extra-hepatic biliary pathways over a period of 10 years, between 1971 and 1980, and 13% of the total number of interventions performed for biliary lithiasis. The advanced age of the patients, the background disease and the complications that accompanied it, as well as the associated deficiencies have given rise to diagnostic and therapeutic difficulties. A correct diagnosis before surgery was made in only two of the patients. The postoperative evolution was good in 13 of the cases (representing 76% of the total), and this confirmed the correct surgical attitude which aimed at restoration of the physiological conditions and a normal digestive and biliary transit. In cases with biliary ileus the first therapeutic measure was to secure intestinal transit.