Biliary enteric fistulas. Management of 47 cases in native Americans.

The management of 47 patients with spontaneous biliary fistulas is reported. Thirteen did not have surgery, and another 8, although operated on, did not have the fistulas closed. In none of these patients have recurrent biliary symptoms developed. The 26 patients who did have surgical closure of the fistula were operated on, in nearly every instance, for symptoms of residual cholelithiasis or choledocholithiasis, and in only 4 of these patients was the fistula known to exist preoperatively.