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April 1975

Biliobiliary Fistula: A Trap in the Surgery of Cholelithiasis

Author Affiliations

From the Unité de Chirurgie Hépato-Biliaire, Université Paris-Sud, Hôpital Paul Brousse, Villejuif, France. Dr. Corlette is presently a Visiting Surgeon with the Harvard Surgical Service, Cambridge Hospital, Cambridge, Mass.

Arch Surg. 1975;110(4):377-383. doi:10.1001/archsurg.1975.01360100019004

Of 24 cases of abnormal communication between gallbladder and main bile duct occurring in a service specializing in hepatobiliary surgery, jaundice was present in all, but variable in degree and persistence. No particular clinical picture suggested this complication of cholelithiasis, and preoperative diagnosis is rare. At operation, adhesions were strikingly dense, often first suggesting a diagnosis of cancer. The gallbladder, fused to the main bile duct, should not be dissected from it because of the risk of ductal injury. Under these conditions, the gallbladder should be opened peripherally, stones extracted, and a cholangiogram performed to assess the situation. Treatment consists of partial cholecystectomy and closure of a cuff of gallbladder wall over a T tube placed into the main bile duct through the fistula.

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