Internal biliary fistulae are one of the more uncommon diseases affecting the upper gastrointestinal tract. Most fistulae are secondary to gallbladder disease and are almost always symptomatic. Clinically, however, the most silent internal biliary fistulae are choledochoduodenal in nature, especially where secondary to penetrating duodenal ulcer. The surgical management of this condition enjoys widespread variation in the literature, undoubtedly owing to the sparsity of cases available for study. It is entirely probable that large numbers of such cases and their complications are undiagnosed yet treated for the underlying peptic ulcer disease.
The incidence of spontaneous internal biliary fistulae is reported in the following Tabulation:
Choledochoduodenal fistulae represent approximately 10% to 20% of all spontaneous internal biliary fistulae (Waggoner and Le-Mone; Garland and
HUTCHINGS VZ, WHEELER JR, PUESTOW CB. Choledochoduodenal Fistula Complicating Duodenal UlcerA Report of Five Cases and Review of the Literature. AMA Arch Surg. 1956;73(4):598-605. doi:10.1001/archsurg.1956.01280040054007