Spontaneous biliary-enteric fistulas; some considerations on the management of gallstones.

During the past ten years a diagnosis of biliary-enteric fistula was made in thirty-five patients. Six were entirely asymptomatic and another seven patients had suffered only mild symptoms for a short period of time. This indicates that the gallbladder can undergo recurrent episodes of inflammation to the point of fistula formation, with little or no clinical signs of symptoms. An aggressive surgical approach is therefore warranted in patients with cholelithiasis, even when silent stones are involved.