[Choledocholithiasis complicated by spontaneous external biliary fistula of the liver].
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Endoscopic papillosphincterotomy was performed in 306 patients with hepatocholedochal calculi. Mechanical jaundice was found in 271 patients (88.5%), 183 patients (59.8%) had acute cholangitis, 41 patients (13.4%) had acute pancreatitis. Complete sanitation of bile ducts was successfully fulfilled in 264 patients (86.3%). Three patients had bleedings from the area of incision, 7 patients had transient diastasuria, 3 patients had edematic form of acute pancreatitis, 24 patients died (7.84%).
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Since its introduction 10 years ago, endoscopic removal of gallstones from the common bile duct has become a widely accepted method. The procedure is successful in approximately 90% of cases. Complications occur in 5-10%, with a reported mortality of 1-2%. Endoscopic removal of gallstones from the common bile duct appears to be the method of choice in the treatment of patients with previous cholecystectomy. Other important indications are acute cholangitis and biliary pancreatitis.
In 4 out of 190 patients, who underwent a cholecystectomy, stones were only found in the common bile duct and none in the gallbladder. The radiological data of these 4 patients were retrospectively analysed. In 2/3 patients sonography showed a dilatation of the common bile duct, whereas stones in the common bile duct were shown by IVC in 2/2 patients, ERCP in 3/3 patients and PTC in 1/1 patients. In 1/3 patients also, in whom an ERCP had been performed, stones were suspected in the gallbladder, but could not be verified during cholecystectomy.
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