[Methods of treatment for suppurative biliary fistulas of amebic etiology]

Experience in the treatment of 43 patients with pyobiliary fistulas which formed after abscessotomy in amebic abscess of the liver is generalized. The fistulas occurred after open drainage in 29 patients, spontaneous opening of the abscess on the external surface of the body in 8, and after operation for transdiaphragmatic opening of a hepatic abscess in 6 patients. Two groups of patients were distinguished according to the method of completion of the operation. Among the 24 patients of the first clinical group 9 were subjected to drainage of the residual cavity with excision of the fistula, biliary fistulas opening into the cavity were closed in 5 patients, and routine drainage of the cavity was performed in other 5 patients. In 5 cases the operation was completed by plastics of the residual cavity with a pedicle diaphragmatic flap. In the second clinical group, filling of the cavity with the omentum was carried out in 13 patients and a variant of operation suggested by the author was used in 6 patients. The organism's immune reactivity was found to be reduced in prolonged existence of the fistula. The author recommends immunostimulants to be included in the therapeutic complex.