[Spontaneous internal biliary fistulae--a report of 4 clinical cases]

This is a report on personal experience had with operative treatment of chronic calculous cholecystitis. Of the total of 228 patients operated on, spontaneous internal biliary fistulas are discovered in 4 cases (1.75 per cent): Mirizzi's syndrome--1 case. Fistula cholecystoduodenalis--3 cases. The development of fistulas is attributed to the elevated intrabladder pressure and activation of the infectious process and destructive changes taking place in the gallbladder wall, with ensuing breakdown and possibility of the concrement to penetrate an adjacent organ. It is presumed that pain localized in the right subcostal area and epigastrium is the symptom most strongly expressed. Cholecystocolonic fistula runs the heaviest clinical course among the patients operated on.