Spontaneous internal biliary fistulas.

Etiology, diagnostic investigations and surgical procedures on 58 patients with spontaneous internal biliary fistulas are reported. Cholelithiasis and peptic ulcer were found to be the presumptive cause of fistula respectively in 53 and five patients. Preoperative diagnosis was established on 31 patients while in the remaining 27 fistula was found incidentally at surgery. Surgical treatment included a wide variety of operations which were performed on the basis of the pathologic features of fistula. Over all mortality rate was 5 percent and morbidity 13 percent. The unsatisfactory results of the surgical treatment of internal biliary fistulas are another strong argument for performing early cholecystectomy in all the patients with cholelithiasis.