[Spontaneous bilio-digestive fistulas. Experience with 27 cases].

A series of 27 cases of biliary-digestive fistulae is presented. 26 were due to calculi and 1 to ulcer and calculi. 20 led to the duodenum, 6 to the colon, and 1 to the stomach from the gallbladder. The series constituted 1.4% of bile ducts operations. Females (mostly multiparae) formed 66%. The mean age was 64 yr. Direct fistulae (66%) had the appearance of surgical openings, whereas the indirect forms (34%) included a fistulous connection between the mucosae of the two organs. There was no distinctive symptomatology. In most cases, the fistula was formed during a serious exacerbation episode of the underlying diseases, whose symptoms, if occasional, tended to become continuous. Pre-operative diagnosis was difficult, though suspicion was present in 44% of cases. Radiological examination is essential for this purpose. Pneumoangiocholia observed during direct examination of the abdomen is virtually pathognomonic. Examination of the bile ducts with contrast medium given venously or per os proved less useful, since the fistula was very difficult to detect; at best, pneumocholecyst between the main duct and the opposing duodenum could be seen. Detection was, on the other hand, possible in over 50% of cases on examination of the digestive apparatus with contrast medium per os or rectally. Treatment consists of removal of the fistula and the disease responsible for it. Very good results were obtained, with a mortality of 3%.