In 1912, Schmilinsky1 reported a case in which a biliary fistula developed after resection of the stomach for ulcer followed by gastro-enterostomy. From 800 to 1,000 c.c. of bile were discharged per day. The stools were acholic. The patient was losing strength so rapidly that it became apparent he could live but a few days longer. Schmilinsky met this crisis by collecting all the bile escaping from the fistula and introducing it into the stomach through a stomach tube twice a day (about 400 c.c. each time). The treatment was kept up for two months. The patient bore it excellently. As the fistula showed no tendency toward closing, an anastomosis was made between it and a loop of jejunum. A cure is reported to have followed.
This eminently simple means of improving the condition of such patients was carried out by me in the following case:
Nov. 25, 1914,
GERSTER JCA. THE FEEDING OF BILE COLLECTED FROM BILIARY FISTULAS IN OBSTRUCTION OF THE COMMON DUCT. JAMA. 1915;LXIV(23):1900. doi:10.1001/jama.1915.02570490016007