Radiological findings in biliary fistula and gallstone ileus.

Abstract

PURPOSE:

Biliary fistula and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material.

MATERIAL AND METHODS:

The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret's syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy.

RESULTS:

Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin meal yielded it in the case of Bouveret's syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas.

CONCLUSION:

Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered.

• Authors: H Oikarinen, M Päivänsalo, T Tikkakoski, A Saarela
• Journal: Acta radiologica (Stockholm, Sweden : 1987) (Acta Radiol) Vol. 37 Issue 6 Pg. 917-22 (Nov 1996) ISSN: 0284-1851 [Print] England
• PMID: 8995466 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Biliary Fistula (complications, diagnostic imaging, etiology)
• Cholelithiasis (complications, diagnostic imaging, surgery)
• Cutaneous Fistula (complications, etiology)
• Female
• Gastric Outlet Obstruction (diagnostic imaging, etiology)
• Humans
• Iatrogenic Disease
• Intestinal Fistula (complications, diagnostic imaging)
• Intestinal Obstruction (diagnostic imaging, etiology)
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed