LeBlanc K A, Barr L H, Rush B M
South Med J. 1983 Oct;76(10):1249-52. doi: 10.1097/00007611-198310000-00013.
Biliary enteric fistulas usually occur as a complication of chronic cholelithiasis, may be difficult to document preoperatively, and often pose problems in surgical management. We reviewed 13 cases of spontaneous biliary enteric fistulas to identify methods of diagnosis, management, and complications. There was no specific set of clinical symptoms or signs that led to the diagnosis of a fistula. In six cases the diagnosis was made preoperatively by x-ray films showing pneumobilia, gallstone in the small bowel, or fistula. Initial surgical treatment included cholecystectomy in six cases, small bowel enterotomy and removal of gallstones in four, and vagotomy and antrectomy in one case. Two patients initially treated without operation were lost to follow-up. Eight complications occurred in six patients, and there were three deaths due to underlying cardiac disease. The morbidity and mortality of biliary enteric fistulas associated with chronic cholecystitis may be avoided by performing elective cholecystectomy when the patient is in optimal condition.
胆肠瘘通常作为慢性胆石症的并发症出现，术前可能难以确诊，且在手术治疗中常引发问题。我们回顾了13例自发性胆肠瘘病例，以确定诊断、治疗方法及并发症情况。没有特定的一组临床症状或体征可确诊瘘管。6例术前通过X线片显示胆道积气、小肠内胆结石或瘘管而确诊。初始手术治疗包括6例行胆囊切除术，4例行小肠切开取石术，1例行迷走神经切断术和胃窦切除术。最初未接受手术治疗的2例患者失访。6例患者出现8种并发症，3例因基础心脏病死亡。对于患有慢性胆囊炎的胆肠瘘患者，在其身体状况最佳时进行择期胆囊切除术，可避免发病和死亡。
