THREE CASES OF BILIOBILIARY FISTULA

• Published in: Japanese Journal of National Medical Services Vol. 39; no. 5; pp. 447 - 451
• Main Authors: NONAKA, Michiyasu, YOSHIDA, Koji, VEDA, Toshiaki, SAITSU, Hideki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1985
• Subjects: Biliobiliary Fistula
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.39.447

Inner biliary fistula, which is one of the complications of cholelithiasis, is a relatively uncommon disease. We reported 3 cases of biliobiliary fistula, which were very rare. They were two women and one man. The age ranged from 40 to 62 years. The chief complaint was jaundice or pain, while all three cases showed jaundice. There were pain in 2 cases; fever in 2 cases, while no symptoms of shock or disturbances of consciousness were seen. The symptoms lasted for over one year in all three cases and more than five years in 2 of them. Before operation, accurate diagnosis of biliobiliary fistula was made in one case, while in the other two cases, tentative diagnosis of choledocholi-thiasis or gallbladder stone with Mirizzi's syndrome was made. The diagnostic method was either echogram or cholangiogram by PTC or PTBD. The fistula were Corette type I in 3 cases. The basic operative methods consisted of cholecystectomy, lithotomy, construction of biliary duct or drainage from biliary tract. However, a large defect in the right side of the bile duct was made after removal of the large stone existing both at hilus of gallbladder and common hepatic duct or choledochus. Since the biliary tract with stone was surrounded by inflammatory changes and was fragile, it was often difficult to make the reconstruction of the biliary tract. For these reasons, incision or removal of the gallbladder or the bile duct should be performed after deciding the operative method carefully, and unreasonable cholecystectomy or the reconstruction of the biliary tract should be avoided. We consider that in these patients, the construction of the biliary tract using patch graft and effective biliary drainage after removal of stone are best operative methods.