Shimono T, Nishimura K, Hayakawa K
Department of Radiology, Kyoto City Hospital, Kyoto, Japan.
Abdom Imaging. 1998 Mar-Apr;23(2):172-6. doi: 10.1007/s002619900314.
To define the signs useful for differentiating between gallbladder-enteric fistula (GB-EF) and common bile duct-enteric fistula (CBD-EF) on computed tomography (CT) because the prognosis and management of the two are different.
CT scans in 13 patients with pneumobilia, who had not had surgical biliary-enteric anastomosis and endoscopic sphincterotomy, were reviewed. The presence of fistula itself, the location of air in the biliary system, and the appearance of the gallbladder were assessed.
The causes of pneumobilia were GB-EF in seven patients, CBD-EF in three patients, emphysematous cholecystitis (EC) in one patient, gallbladder cancer (GBC) in one patient, and incompetent sphincter of Oddi in one patient. In three of seven GB-EF patients (43%) and in none of the three CBD-EF patients (0%), the fistula itself was detected. Air was detected in the common bile duct in four of seven GB-EF (57%) and in all three CBD-EF (100%) patients, and GBC. In six of seven GB-EF (86%) and in one of three CBD-EF (33%) patients, the gallbladder was contracted. Thus, the location of air and the contraction of gallbladder were useful signs to differentiate GB-EF from CBD-EF.
CT can distinguish between GB-EF and CBD-EF.
由于胆囊-肠瘘（GB-EF）和胆总管-肠瘘（CBD-EF）的预后和治疗方法不同，因此需要确定在计算机断层扫描（CT）上有助于区分这两种瘘的征象。
回顾了13例未进行过外科胆肠吻合术和内镜括约肌切开术的气肿性胆囊炎患者的CT扫描结果。评估瘘本身的存在、胆道系统中气体的位置以及胆囊的外观。
气肿性胆囊炎的病因包括7例GB-EF、3例CBD-EF、1例气肿性胆囊炎（EC）、1例胆囊癌（GBC）和1例Oddi括约肌功能不全。在7例GB-EF患者中的3例（43%）检测到了瘘本身，而3例CBD-EF患者中无一例（0%）检测到。在7例GB-EF患者中的4例（57%）以及所有3例CBD-EF患者（100%）和GBC患者的胆总管中检测到了气体。在7例GB-EF患者中的6例（86%）以及3例CBD-EF患者中的1例（33%）胆囊收缩。因此，气体的位置和胆囊收缩是区分GB-EF和CBD-EF的有用征象。
CT可以区分GB-EF和CBD-EF。
