Biliobiliary fistulae constitute one of the nonmalignant complications of gallstone disease. Never diagnosed before the operation—either clinically or roentgenologically—they are exclusively an operating-table finding. They always occur in connection with long-standing lithiasis. In our practice we have been able to observe several patients with this type of complication.
Etiologically this condition is directly related to the impaction of stones at some level of the biliary tract, where they originate "decubitus" lesions. The calculus obstructs the bile flow and its pressure on the wall impairs the local circulation at the site of impaction. There is venous congestion, followed later by arterial ischemia, leading to the infarction of the "decubitus" plaque, with or without contamination of the stagnant bile. At the affected zone, the normal elements of the wall are replaced by scar tissue, leaving a "locus minoris resistentiae." The process can more frequently be observed at the neck of
LASALA AJ, SAPORTA JA. Biliobiliary Fistulae: Our Experience with Eight Cases. AMA Arch Surg. 1960;80(3):486–488. doi:10.1001/archsurg.1960.01290200130023
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