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CT imaging of biliary enteric fistula
T Shimono1, K Nishimura, K Hayakawa
1Department of Radiology, Kyoto City Hospital, Kyoto, Japan.
Abdominal Imaging
|March 28, 1998
Summary
Computed tomography (CT) can differentiate gallbladder-enteric fistula (GB-EF) from common bile duct-enteric fistula (CBD-EF). Key signs include the location of air in the biliary system and gallbladder contraction.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Pathology
Background:
- Gallbladder-enteric fistula (GB-EF) and common bile duct-enteric fistula (CBD-EF) have different prognoses and management strategies.
- Accurate differentiation on computed tomography (CT) is crucial for appropriate patient care.
Purpose of the Study:
- To identify CT signs that reliably distinguish between GB-EF and CBD-EF.
- To improve diagnostic accuracy in patients presenting with pneumobilia.
Main Methods:
- Retrospective review of CT scans from 13 patients with pneumobilia.
- Exclusion criteria included prior surgical biliary-enteric anastomosis and endoscopic sphincterotomy.
- Assessment of fistula presence, air location within the biliary system, and gallbladder morphology.
Main Results:
- Pneumobilia causes included GB-EF (7 patients), CBD-EF (3 patients), emphysematous cholecystitis, gallbladder cancer, and incompetent sphincter of Oddi.
- Fistula detection rates were 43% for GB-EF and 0% for CBD-EF.
- Air in the common bile duct was seen in 57% of GB-EF and 100% of CBD-EF patients.
- Gallbladder contraction was observed in 86% of GB-EF and 33% of CBD-EF patients.
Conclusions:
- CT is effective in differentiating between GB-EF and CBD-EF.
- The location of air within the biliary tree and gallbladder contraction are significant differentiating features.