[Internal biliodigestive fistulas]

Experience in surgical treatment of 53 patients with internal biliodigestive fistulas is analysed. The formation of the fistula in all cases was caused by cholelithiasis with obstruction of the bile ducts, purulent cholangitis, angiocholitis, cholangiolytic abscesses of the liver, pancreatitis, hepatitis, as well as cholelithic ileus. Cholecystectomy, removal of the stones from the bile ducts, restoration of the main route of bile drainage, elimination of the pathological communication, and closure of the defect in a hollow organ should be considered the operation of choice. In cholelithic ileus operation for correction of the intestinal obstruction is also expedient. Postoperative complications were encountered in 35.8% of cases. Hepatorenal insufficiency developed in 8, incompetence of the choledochus sutures in 3, an external biliary fistula in 2, hepatic abscess in 1, pancreatitis in 2, and suppuration of the postoperative wound in 3 patients. Among the 53 patients treated by operation, 49 (92.5%) recovered and 4 (7.5%) died from various postoperative complications.