Internal biliary fistula due to cholelithiasis: A single-centre experience

Table 1 The characteristics of the patients

No.	Age/sex	Pre-operative diagnosis	Peri-operative findings	Operation	Hospitalstay (d)	Morbidity duringpostoperative course
1	69/F	Gallstone ileus	Double CDF + gallstone ileus + iatrogenic sigmoid perforation	Cholecystectomy + enterolithotomy + T-tube + primary sutures to duodenal wall + Bogota bag + primary colon repair	45	Bile leakage
2	80/M	Acute abdomen, Acute appendicitis? İleus?	Gallstones, CDF + jejunal mass + gallstone ileus	Cholecystectomy + choledochotomy + T-tube + primary sutures to duodenum + tube duodenostomy + appendectomy + jejunotomy + removal of stone	16	Myocardial infarction, death
3	60/M	Obstructive jaundice choledocholithiasis	CCDF	Partial cholecystectomy + repair of common bile duct over T-tube	20	Wound infection
4	22/M	Cholecystocholedochol-ithiasis	Adhesions, conversion to laparotomy, CDF, acutecholecystitis	Cholecystectomy + T tube insertion + primary sutures to duodenal wall	10	NC
5	67/F	Cholelithiasis	Adhesions, conversion to laparotomy, CDF	Cholecystectomy + primary sutures to duodenal wall	8	NC
6	54/F	Acute abdomen	CDF	Cholecystectomy + choledochotomy +T-tube insertion + primary sutures to duodenal wall	8	NC
7	71/M	Choledocholithiasis	Mirizzi’s syndrome, CDF	Cholecystectomy + choledochotomy + T tube insertion + primary sutures to duodenal wall	6	NC
8	30/F	Cholelithiasis	CDF	Cholecystectomy + primary sutures to duodenal wall	4	NC
9	66/M	Cholelithiasis	Adhesions, conversion to laparotomy, CDF	Cholecystectomy + T-tube insertion + primary sutures to duodenal wall	8	Wound infection
10	38/M	Acute cholecystitis	Acute cholecystitis, CDF	Cholecystectomy + T-tube insertion + primary sutures to duodenal wall	34	ARDS, death
11	62/M	Acute abdomen, gallbladder perforation	CDF, perforation of gallbladder, pleural effüsion	Cholecystectomy + T-tube insertion + primary sutures to duodenal wall + chest tube insertion1	28	GI bleeding, bile leakage, sepsis, death
12	70/F	Acute cholecystitis, obstructive jaundice	CCDF, acute cholecystitis	Cholecystectomy + Hepaticojejunostomy	25	Bile leakage

CDF: Cholecystoduodenal fistula; CCDF: Cholecystocholedochal fistula; NC: No complications.

¹This is the primary operation performed. Patient also underwent repeated procedures due to bile leakage.

Table 2 Data on diagnosis and management of internal biliary fistula in literature

Authors	Case number	Peri-operative findings	Procedure
Silecchia[18]	5	CCDF, Type II Mirizzi syndrome	NA
Carlei[19]	5	CDF	LC + repair
Angrisani[6]	34	CDF, CJF, CCF.	LC + repair in 14 patients, Conversion to laparatomy in 20 patients
Moreno Ruiz[20]	17	14 CDF, 3 CCF, 2 CGF	LC + repair

NA: Surgical data not available; LC + repair: Laparoscopic cholecystectomy + fistula repair; CDF: Cholecystoduodenal fistula; CCDF: Cholecystocholedochal fistula; CCF: Cholecysto-colic fistula; CGF: Cholecystogastric fistula; CJF:Cholecystojejunal fistula.