[Bilio-digestive fistulas]

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.