Chirurgia (Bucur). 2021 Dec;116(6 Suppl):S28-S35.
Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or gastrointestinal disease. Iatrogenic fistulas, due to surgery or instrumental exploration, are not included in this definition. R. Colombo, in 1559, was the first to describe SBEF as an occasional finding during an autopsy. In almost 90% of cases the cause of SBEF is chronic recurrent cholelithiasis. Less common causes are penetrating peptic ulcers and neoplastic infiltration from the biliary or gastrointestinal tract. The most common type of SBEF is cholecystoduodenal fistula and the least common is choledochoduodenal fistula. There are various complications associated with SBEF but often these are not promptly recognized by patients or physicians and diagnosis and treatment may be delayed for years. The most important complication, which can be considered pathognomonic for SBEF, is gallstone ileus which manifests clinically as acute or chronic mechanical intestinal obstruction. Gallstone ileus, a rather rare complication of a rather common pathology, biliary lithiasis, is found in 0.000015% of hospitalized patients but in 0.0003% of surgical patients. It is mainly found in women over the age of 65, with a male to-female ratio of 1:5. There are various forms of occlusion, related to the sites of gallstone impaction, with various clinical characteristics and degrees of severity. These include Bouveret syndrome ( 10% of cases) with impaction in duodenum or pylorus, and the more common Barnard's syndrome (5-75% of cases) in which the site of impaction is in the terminal ileum right before Bauhin's valve. For diagnosis, the radiological signs which make up Riglerâ??s triad or tetrad, are essential, and are best visible on magnetic resonance. The the gold standard is contrast-enhanced computed tomography scan. Regarding the surgical management, one-stage simple enterolithotomy is reserved for the oldest patients and the most severe cases. Nowadays, is performed more and more frequently by laparoscopy. In more favorable cases radical treatment of the occlusion, the biliary lithiasis and the SBEF is recommended, either as a one-stage procedure or in two stages with the second procedure performed after few weeks.
自发性胆肠瘘（SBEF）是指胆道系统与胃肠道之间出现的异常通道，由胆道或胃肠道疾病引起。本定义不包括医源性瘘管，这些瘘管是由于手术或器械探查引起的。1559 年，R. Colombo 首次在尸检中描述了 SBEF 是一种偶发发现。在近 90%的情况下，SBEF 的病因是慢性复发性胆石症。较少见的病因是穿透性消化性溃疡和来自胆道或胃肠道的肿瘤浸润。最常见的 SBEF 类型是胆囊十二指肠瘘，最不常见的是胆总管十二指肠瘘。SBEF 可伴有各种并发症，但这些并发症通常不会被患者或医生及时识别，诊断和治疗可能会延迟数年。最重要的并发症，可认为是 SBEF 的特征性并发症，是胆石性肠梗阻，其临床表现为急性或慢性机械性肠梗阻。胆石性肠梗阻是胆道结石这一相当常见的病理变化的一种罕见并发症，在住院患者中的发生率为 0.000015%，但在手术患者中的发生率为 0.0003%。它主要发生在 65 岁以上的女性中，男女比例为 1:5。有各种形式的阻塞，与胆石嵌顿的部位有关，具有不同的临床特征和严重程度。这些包括 Bouveret 综合征（10%的病例），胆石嵌顿在十二指肠或幽门；更常见的 Barnard 综合征（5-75%的病例），胆石嵌顿在回肠末端，正好在 Bauhin 瓣之前。对于诊断，构成 Riglerâ??s 三联征或四联征的影像学征象至关重要，在磁共振上最易显示。金标准是增强 CT 扫描。对于手术治疗，一期单纯取石术保留给最年长和最严重的患者。如今，越来越多地通过腹腔镜进行。在更有利的情况下，建议对阻塞、胆石症和 SBEF 进行根治性治疗，无论是一期手术还是两期手术，第二期手术在几周后进行。
