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July 1948

COMPLETE STRICTURE OF THE EXTRAHEPATIC BILE DUCTS: External Hepaticostomy Followed By Spontaneous Hepatoduodenal Fistula

Author Affiliations

Fellow in Surgery, Mayo Foundation ROCHESTER, MINN.
Dr. Walters is in the Division of Surgery at the Mayo Clinic.

Arch Surg. 1948;57(1):18-23. doi:10.1001/archsurg.1948.01240020021003

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WE WISH to report 6 cases of complete stricture of the extrahepatic bile ducts in which external hepaticostomy was followed by the spontaneous development of a hepatoduodenal fistula. In 5 of these cases no effort was made to create an anatomic condition which would favor the development of such a fistula. A rubber catheter was sutured into the intrahepatic duct to create an external biliary fistula in the first 2 cases. It was the intention of the surgeon (W.W.) to transplant the fistulous tract into the intestine at a later date, but a fistula developed between the bile duct and the intestine in the interim. Owing to the gratifying result obtained in these cases, one of us (W.W.) decided to use a similar surgical procedure in the next case of complete stricture of the extrahepatic bile ducts in which an anastomosis could not be effected between a patent bile duct

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