Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

Abstract

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

Atypical presentation and clinical management of jaundice secondary to Choledocoduodenal fistula: A Case Report

“…5 There are two types of distal CDDFs: Type 1 tends to be smaller in size secondary to smaller gall stones entering the intramural portion of the duodenum leading to fistula adjacent to the longitudinal fold along with duodenal papillae; and Type 2 tends to be bigger due to impaction of large stone on the extramural portion of CBD leading to fistula proximal and adjacent to duodenal fold. [6][7][8] In our case, we can see that patient had multiple abscesses in and around the gall bladder leading to its poor visualization along with pneumobilia (Image A). Due to this, it was very difficult for us to decipher if patient had concurrent gall stones along with cholangitic abscesses and fistula.…”

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

“…Visoki ileus, ki ga povzroči zapora dvanajstnika z žolčnim kamnom, poznamo tudi pod imenom Bouveretov sindrom (10). V grobem lahko razdelimo biliarne fistule na primarne, ki so posledica žolčnih kamnov, in sekundarne, ki se pojavijo v sklopu zapletov po kirurških posegih (11). Incidenca primarnih biliarnih fistul je 1-2 %.…”

“…po abdominalnem drenu. Če po operaciji ne dreniramo trebušne votline, se kot posledica nabiranja žolčne vsebine v trebušni votlini razvije biliarni peritonitis (11). Ob sumu na biliarno fistulo napravimo najprej ultrazvočni pregled trebuha, s katerim ocenimo prisotnost proste tekočine ali večjih tekočinskih kolekcij v trebušni votlini.…”

Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor – Case Report

“…Based on their etiology, biliary fistulae can be spontaneous, therapeutic, traumatic and iatrogenic [1]. As a result of the introduction of biliary tract surgery, iatrogenic fistulae replaced spontaneous fistulae as the most common type [2]. …”