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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Multi-technical management of biliary fistula].

Biliary fistula is an occasional complication of cholecystectomy and are usually associated to retained biliary stones, surgical trauma of the biliary ducts and local infection. They were mainly treated by surgical methods up to the acquisition of the new endoscopic and percutaneous techniques used together with parenteral and enteral nutrition and new antibiotics. A total of seven patients with diagnosis of biliary fistula were seen between 1984 and 1990 at the "Unidad de Gastroenterología y Cirugía Digestiva" of the Clínica Sanatrix en Caracas. Average age was 50 with ranged between 31 and 76, 4 were male and 3 female. The fistulas were in 1 due to necrotizing pancreatitis, in 3 to lost of the ligation of the cystic duct, 2 were due to accidental injury of the common duct and the last case was a partial dehiscence of a choledoco-jejunostomy after the resection of a common duct cyst. Four of the cases were choledoco-cutaneous fistula, one hepatocutaneous, two hepatoduodenal. All the seven patients had subhepatic collections, one had a retroperitoneal collection, two had subdiaphragmatic collections and one had multiple hepatic abscesses. The abdominal collections were treated by percutaneous drainage using mainly the Ring-McLean and Van Sonnenberg tubes. The fistula was occluded with biliary prosthesis in four cases, using either endoscopic, percutaneous or mixed technique to place the stent. Patency of the stents ranged between 2 weeks and 24 months. Control time was from 2 to 40 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Endoscopic management of postoperative biliary fistulas].

Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

Adolescent↗
PubMed1994

[Methods of treatment for suppurative biliary fistulas of amebic etiology].

Experience in the treatment of 43 patients with pyobiliary fistulas which formed after abscessotomy in amebic abscess of the liver is generalized. The fistulas occurred after open drainage in 29 patients, spontaneous opening of the abscess on the external surface of the body in 8, and after operation for transdiaphragmatic opening of a hepatic abscess in 6 patients. Two groups of patients were distinguished according to the method of completion of the operation. Among the 24 patients of the first clinical group 9 were subjected to drainage of the residual cavity with excision of the fistula, biliary fistulas opening into the cavity were closed in 5 patients, and routine drainage of the cavity was performed in other 5 patients. In 5 cases the operation was completed by plastics of the residual cavity with a pedicle diaphragmatic flap. In the second clinical group, filling of the cavity with the omentum was carried out in 13 patients and a variant of operation suggested by the author was used in 6 patients. The organism's immune reactivity was found to be reduced in prolonged existence of the fistula. The author recommends immunostimulants to be included in the therapeutic complex.

Adjuvants, Immunologic↗
PubMed1991

Endoscopic treatment of postoperative biliary fistulae.

Postoperative biliary fistulae are difficult to manage, particularly in the face of obstruction or malignancy. We used endoscopic sphincterotomy or endoprosthesis placement to aide fistula closure in 52 patients with postoperative biliary fistulae. Thirty-seven patients with a fistula were treated with endoscopic sphincterotomy alone. Twenty-four of these 37 patients had a history of lithiasis; 21 patients were treated successfully by endoscopic sphincterotomy alone. The fistula closed in 2.4 +/- 1.6 days. Among the other 13 patients without history of stone disease, the fistula closed in seven cases (54%), 8.4 +/- 2 days after endoscopic treatment. Three patients ultimately required surgical intervention. In 15 patients an attempt was made to pass a 10F endoprosthesis above the fistula. Among the eight patients with successful prosthesis insertion, the fistula healed in six patients (75%). In the seven patients in whom a prosthesis could not be passed endoscopically, the percutaneous transhepatic approach was used. Surgical treatment (hepaticojejunal anastomosis) was ultimately required in two of these seven patients. Sphincterotomy alone is the preferred treatment for biliary fistulae-complicating surgery for gallstone disease. Alternatively, when a fistula is large, endoscopic placement of a prosthesis can be proposed as the first treatment. In cases of endoscopic failure, placement of a prosthesis through the percutaneous transhepatic approach is a useful alternative, particularly when the fistula source is located in the intrahepatic biliary tract.

Biliary Fistula↗
PubMedDate not supplied

[Mini-invasive treatment, through endoscopic papillo-sphincterectomy, of post-surgery biliary fistulae].

External biliary fistulas associated both with open and laparoscopic biliary surgery, need a quick solution to prevent local and general complications. Open surgical treatment was the only solution until the minimally invasive techniques, such as endoscopy, were developed. The authors present 10 cases of postoperative external biliary fistulas, successfully treated by endoscopic papillosphincterotomy alone, technique which is compatible with other endoscopic procedures of treatment, performed in association with endoscopic papillosphincterotomy or not.

Adult↗
PubMed1975

External biliary fistula.

External biliary fistulas, once common, are now rare: before the present report of 4 cases only 27 cases have been reported in the English literature since 1900. Review of the records of four patients with external biliary fistula confirmed its occurrence in patients over 50 years of age and the variable site for operning of the fistulous tract. Cholecystectomy provided successful treatment in three of the four patients but the fourth was too ill to undergo an operation; in general, definitive treatment is cholecystectomy, together with excision of the fistulous tract if this takes a direct path through the abdominal wall from the gallbladder, or curettage if the course is devious.

Aged↗
PubMedDate not supplied

External biliary fistula.

A biliary fistula is almost invariably related to gallstone disease and commonly follows a hurried cholecystectomy by an inexperienced surgeon. This catastrophy which is largely preventable, often necessitates repeated surgical intervention and accrues an estimated 5-year mortality rate approaching 30%. Published series only show a slight increase in the incidence (one per 150-200) after laparoscopic cholecystectomy. The injury results from imprecise dissection and inadequate demonstration of the anatomical structures. The diagnosis is usually obvious and persistent tachycardia and hypotension inspite of an adequate intravenous infusion and a normal central venous pressure is another well known indicator of subhepatic collection of bile, which indicates an urgent ultrasonographic scanning of the upper abodmen. ERCP is a useful diagnostic and therapeutic tool when the continuity of the extra-hepatic biliary system has not been disrupted. An endobiliary stent can be placed across the defect in the same sitting, to tide over the immediate crisis and perhaps treat the patient on a permanent basis. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive technique of outlining both the intra and extrahepatic biliary tree, which can provide a better road map of the fistula than an ERCP. The management has to be tailored to the patient's condition and the expertise available. A bilio-enteric anastomosis, performed 4 to 6 months after the initial surgery on a dilated common hepatic duct is more likely to succeed than an operation on a septic, hypoproteinemic patient with sodden, friable, non-dilated bile ducts. On the other hand, waiting for the ducts to dilate in a patient with a complete transection of the bile ducts with complete biliary diversion only leads to depletion of the bile acid pool, severe electrolyte derangement and nutritional failure, leading on to sepsis and death.

Bile Duct Diseases↗
PubMed1987

Spontaneous closure of an end biliary fistula.

Most biliary cutaneous fistulas are side fistulas that communicate with the main biliary ductal system. As long as distal obstruction is not present, nearly all fistulas will close spontaneously. The present case of an end biliary fistula due to transection of an aberrant bile duct during cholecystectomy and its successful nonoperative management demonstrate that end fistulas can sometimes be managed without operative intervention.

Adult↗
PubMed1989

[Spontaneous external biliary fistula].

Spontaneous biliary cutaneous fistula is a rare complication of inflammatory perforation of the gallbladder. We describe a 70-year-old woman who developed a fistula between the gallbladder and the skin following drainage of an abdominal wall abscess. In such cases primary drainage of the abscess alone is advisable. Only after the active infection has subsided should definitive cholecystectomy and excision of the fistulous tract be carried out.

Abdominal Muscles↗
PubMed1994

[Endoscopic therapy of postoperative biliary fistula].

A postoperative biliary fistula is a rare but severe complication of biliary surgery. Clinical signs, ultrasound and ERC lead to the diagnosis. Within three years, 37 patients with postoperative bile duct fistulas after cholecystectomy underwent endoscopic therapy. In all patients the biliary fistula healed completely within seven days after insertion of a nasobiliary tube. The nasobiliary tube for postoperative biliary fistulas offers regular radiological controls and reduces the necessity of operative reinterventions on the biliary system.

Biliary Fistula↗
PubMed1997

Post-cholecystectomy external biliary fistula.

BACKGROUND: External biliary fistula (EBF) following bile duct injury is a serious complication of cholecystectomy. METHODS: From January 1989 to December 1994, 37 patients with post-cholecystectomy external biliary fistula were seen at this centre. There were 14 partial, 22 complete and one sub-vesical duct of Luschka injury. Sixteen patients had a controlled EBF at presentation; 10 patients had intra-abdominal collections and seven patients presented with peritonitis. RESULTS: A staged approach to the management of these patients was adopted in which the initial management aimed at creating a 'controlled' fistula. This approach comprised conservative treatment (n = 9), percutaneous catheter drainage of intra-abdominal collections (n = 10), biliary drainage (n = 6), and surgical intervention (n = 7). One patient died because of progressive liver failure in spite of intensive management. Definitive management comprised the surgical repair of biliary strictures wherever indicated, after waiting for the acute problems to settle. CONCLUSIONS: By adopting a staged approach along with a judicious use of endoscopy, radiology and surgery that were based on clinical circumstances, it was possible to achieve satisfactory results for this otherwise distressing condition.

Adult↗
PubMed2001

Nonoperative therapy of the posttraumatic biliary fistula in adolescents.

Posttraumatic biliary fistula is one of the complications of major hepatic injury. Conventional treatment has consisted of surgical intervention with hepatic debridement, ductal repair, and controlled drainage. The authors present two boys, 15 and 17 years of age, with biliary fistulas resulting after major hepatic injury. Biliary fistulas were successfully treated nonoperatively with sphincterotomy and endoscopically inserted small-caliber stents. The duration of time between stent placement and closure of the fistulas were 2 and 8 days, respectively.2.5 years after injury, both patients are without problems. These cases demonstrate the effectiveness of nonoperative management of traumatic biliary fistulas in adolescents.

Adolescent↗
PubMed1995

Efficacy of hepatobiliary scintigraphy in demonstrating cholangio-colic fistulae. Is formation of internal biliary fistula related to external leak closure?

The authors present four cases of internal biliary fistulae (IBF) identified on hepatobiliary scintigraphy. All of the cases share common history of external biliary leak closure. Scintigraphy in all four cases showed a similar pattern of direct visualization of transverse colon without any significant small bowel activity. This suggests an increased frequency of IBF formation in cases with external fistulous tract closure. Retrospectively, it appears that spontaneous closure of external leak may be pathological consequence of formation of IBF involving hepatic flexure.

Adult↗
PubMed1992

Closure of a controlled biliary fistula complicating partial cholecystectomy with endoscopic biliary stenting.

An elderly woman presented 2 months after partial cholecystectomy performed for gangrenous cholecystitis with choledocholithiasis and a controlled biliary fistula. Despite ductal clearance of stones via endoscopic retrograde sphincterotomy and stone extraction, bilious drainage via the fistulous tract persisted. Endoscopic insertion of a 10F Amsterdam endoprosthesis resulted in complete closure of the fistula within 6 wk. This case represents the first example of closure of a biliary fistula after partial cholecystectomy.

Aged↗