bilio digestive fistulas

Chronic lythiasic cholecystitis is a disease distinguished by the pathologic changes because of the chronic inflammation of the biliary extrahepatic tree. Sometimes these morphological changes are associated with internal biliary fistulas arising spontaneously in patients with advanced calculus cholecystitis. The vast majority of fistulas result from the adherence of the inflamed gallbladder or common bile duct to an adjacent viscus and erosion of the gallstones into the adherent organ. The authors analyze an amount of 43 patients with bilio-biliary and bilio-digestive lythiasic fistulas, caused by the long evolution of chronic lythiasic atrophic cholecystitis, for 126 cases which were operated in the Surgery Department of the Caritas Clinic Hospital along 20 years...

BACKGROUND: Gallstone ileus represents 1-3% of mechanical obstructions of the bowel. The surgical treatment performed in urgency has a mortality rates of 10-13% because galistone ileus is frequent in the elderly. Some diagnostic and therapeutic problems are debated in this paper. METHODS: 9 cases of gallstone ileus were analysed retrospectively in a series of 736 mechanical obstructions of the bowel submitted to surgery since 1969. The Authors report the clinical and physical data, the laboratory data and the results of the radiological procedures performed (plain abdominal X-ray, abdominal US, CT, MNR)...

Acute acalculous cholecystitis is rare in non critically ill or postoperative patients. We report a case of acute acalculous cholecystitis with secondary bile infection with Clostridium perfringens. Ultrasound and tomodensitometry revealed diffuse aerobilia. The germ in this case report is atypical and contrasts with the very discrete clinical findings. Aerobilia, secondary to the development of bacteria in the biliary tract falsely suggested a bilio-digestive fistula. Treatment included a simple cholecystectomy associated with 7 days of antibiotherapy...

Mirizzi's syndrome is a rare complication of long-standing cholelithiasis. Many surgical approaches of varying complexity have been advocated for treatment. However, the distorted extrahepatic biliary anatomy continues to be threatening, with a high risk of biliary complications. Presented here is a series of 25 patients with Mirizzi's syndrome who were treated at the Dokuz Eylul University Hospital since 1985. Type I lesion (without cholecystocholedochal fistula) was encountered in 11 patients, while the remaining 14 had type II lesions (with cholecystocholedochal fistula)...

The Authors report their experience with spontaneous bilio-digestive fistulas of lithiasic origin. They examine the difficulties of diagnosis and treatment of this pathology also in consideration of probable complications, in particular the biliary ileus, in old patients often presenting metabolic or cardiopulmonary disorders, which contribute to worsen the prognosis.

UNLABELLED: Gallstone ileus is a rare, serious condition, requiring emergency surgery. Although most data in the literature confirm the need for a conservative surgical approach, several authors report the one-stage repair of the cholecystoduodenal fistula. The present study deals with seven cases of gallstone ileus operated upon in a 20-year period. The patients were in their seventh decade; three men and four women. All the cases had clinical evidence of intestinal obstruction which was confirmed by radiologic examination, and emergency operations were performed...

In the period 1946-1987 at the former Second Surgical Clinic of the Medical Faculty in Belgrade 25 patients with a biliary ileus were Surgically treated, 20 females (80%), and 5 males (20%), aged from 53 to 87 years, (mean 67 years). Six patients were decade, 7 in 7th, 9 in 8th, and 3 in 9th decade. In only 8 patients biliary calculosis had been confirmed earlier. Preoperative troubles in the Bowel Passage lasted 1-7 days, (mean 3 days), mostly as in incomplete gut occlusion. Preoperative diagnosis of the biliary ileus, using x-ray, was exact only in 3 cases (12%), while other remaining patients underwent Surgery diagnosed as ileus of the small bowel or acute abdomen...

The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct...

With an advent of cholangiofiberscope in 1975, tremendous changes have been made in thinking way on the treatment of biliary tract stones. The technique of percutaneous transhepatic cholangioscopy (PTCS) was detailed and its clinical significance was discussed in this paper. PTCS is the technique which is conducted by insertion of cholangiofiberscope into the biliary tract through the dilated fistula produced by percutaneous transhepatic biliary drainage (PTBD). Advantages of this techniques are; (1) it is applicable to the cases who had had bilio-enteric anastomosis or gastro-jejunostomy before, (2) it can be repeatedly carried out if the fistula is maintained open, (3) stones visible are readily removable with the instruments guided by cholangiofiberscope and finally, (4) the informations necessary to select an adequate surgical procedure can be obtained by PTCS, because biliary architecture is clearly delineated...

The authors had 51 patients with iatrogenic injuries to the bile ducts. This complication occurred most frequently in cholecystectomy (45 patients). The injury was localized in the distal segment of the supraduodenal part of the hepaticocholedochus in 11, at the junction of the cystic and hepatic ducts in 15, and in the region of the opening of the hepatic ducts in 23 patients; the lobar hepatic ducts were injured in 2 patients. Injury to the bile ducts was recognized during the first operative intervention in 13 patients, in 8 of them restorative operations could be performed...

On the basis of one case, the authors give the highlights on the various clinicopathological features of malignant gastric perforations. While medical imaging does not seem to contribute much in the positive diagnosis of such complications, it does remain essential to establish the local extension of the tumour process and thus to allow a better therapeutic management.

The clinical and radiological picture observed in a female patient with cholelithiasis urgently hospitalised for abdominal occlusion is described. Radiological examination of the digestive tract disclosed a bilio apico-bulbar fistula and ectasis and hypotonia of the jejuno-ileal loops. A large calculus composed of calcium salts and cholesterine buried in a sigmoid loop was spontaneously passed by the patient during the examination. This resulted in regression of the symptoms of pain and occlusion. Cholangiocholecystography and examination of the digestive tract 3 months later showed a normal gallbladder picture, and disappearance of the fistula...

Two cases of gallstone ileus are reported. Treatment of the occlusion and the underlying bilio-digestive fistula should be carried out in one surgery session. Careful preoperative preparation of these patients from the hydric, electrolytic and metabolic viewpoints is the indispensable premise for single session treatment.

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After a short review of world literature on the subject, four cases of biliary ileus, all with favourable outcome, are reported. Some considerations on the pathogenesis of occlusion of biliary origin and on its treatment are then set out: such treatment must always be surgical and of emergency type, providing not only for removal of the obstructing calculus, but also for exploration of the whole ileus. Where possible, cholecystectomy and closure of the bilio-digestive fistula should also be performed.

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Intraoperative lesions of the extrahepatic bile ducts during cholecystectomy do occur; the incidence is about 0.2 to 0.8%. Lesions of the hepatic duct and the choledochus duct followed by stenosis (usually of the cystic duct confluent) do occur most frequently. Intraoperative ligation of the hepatic duct or the choledochus duct are the most severe sequelae of biliary surgery; the leading symptom is progressive postoperative obstructive jaundice. A bilio-digestive fistula may be formed spontaneously and may masquerade this complication leading to relapsing cholangitis...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.