Presentation
Abstract The authors present four cases of internal biliary fistulae (IBF) identified on hepatobiliary scintigraphy. All of the cases share common history of external biliary leak closure. [ncbi.nlm.nih.gov]
Two of the patients presented with acute cholangitis and 2 presented with bowel obstruction due to gallstone ileus. All the patients underwent surgical treatment and the diagnostic and therapeutic management of each of them was analyzed. [revistagastroenterologiamexico.org]
We report the 10th English- language published case of a CDF that presented with hemorrhagic shock due to massive UGIB [ 5 - 13 ]. [omicsonline.org]
The present paper describes 3 such cases which were incidentally picked up on upper gastro-intestinal (GI) radiographic study and endoscopy done for ulcer like symptoms. The relevant literature is reviewed. [jpgmonline.com]
Entire Body System
- Malnutrition
Fistulas associated with a concurrent pancreatic fistula also have a low rate of spontaneous closure, as do those occurring in the presence of malnutrition or adjacent infection. [sites.google.com]
You’re more likely to develop a fistula if you have: cancer radiation treatment to your abdomen a bowel obstruction surgical suture problems incision site problems an abscess an infection a hematoma, or blood clot under your skin a tumor malnutrition [healthline.com]
Malnutrition, underlying infection, immunosuppression and advanced age play their role; as does surgeon inexperience. Clinical Spectrum The clinical presentation may be obvious when bile stained fluid discharges from the operative wound. [ptolemy.ca]
- Collapse
Chest radiography and CT scan showed subsegmental collapsed consolidation in right lower lobe (Figure-1A and B, black arrows), and large intrahepatic collection (Figure-1B, red arrow). [pjms.com.pk]
[…] hepatic fibrosis Choldedochal cyst (jaundiced child) an anomalous insertion of the CBD into the pancreatic duct Choledocholithiasis (stones in bile duct) * MOST COMMON cause of biliary obstruction * -rapid dilation of ducts proximal to obstruction; collapse [quizlet.com]
Gastrointestinal
- Hematemesis
Most cases of severe bleeding manifested primarily by hematemesis. Only slight melena occurred in some cases [ 19 ]. [omicsonline.org]
[…] their nonspecific clinical presentation, they are divided into 2 types: the non-obstructive type that produce recurrent cholangitis, malabsorption syndrome, and weight loss, and the obstructive type that develop gallstone ileus or Bouveret syndrome, hematemesis [revistagastroenterologiamexico.org]
Cardiovascular
- Thrombosis
K63.2 Fistula of intestine K63.3 Ulcer of intestine K63.8 Other specified diseases of intestine K63.81 Dieulafoy lesion of intestine K63.89 Other specified diseases of intestine K63.9 Disease of intestine, unspecified K64 Hemorrhoids and perianal venous thrombosis [icd10data.com]
As this was a bile leak rather than bleeding, coils were thought to be inappropriate, as they rely on the promotion of thrombosis for their occlusive effect. [kjronline.org]
Spontaneous cholecystocutaneous fistula presenting with a cellulitis and portal vein thrombosis. J Clin Gastroenterol. 2002 Jan. 34(1):99-100. [Medline]. Flora HS, Bhattacharya S. Spontaneous cholecystocutaneous fistula. [emedicine.medscape.com]
It provides a permanent embolization and hence, due to an inflammatory tissue response, a long-term occlusion in vessels of various size resulting in vessel thrombosis or tissue atrophy. [14], [15], [17] Vu et al ., [14] based on their experience with [ijri.org]
Liver, Gall & Pancreas
- Biliary Colic
[…] tract that presents as biliary colic, jaundice and cholangitis. [ 3 ] Intrabiliary rupture is reported to be seen in a range of 1-17% in such cases. [ 4 ] Cyst diameter of 7.5 cm and above is an independent factor that is associated with a high risk [oapublishinglondon.com]
Musculoskeletal
- Osteoporosis
His comorbidities included hypertension, chronic renal failure, osteoporosis and gout. He had no past surgical history. Two months prior, he was admitted to an outside hospital due to similar presentation. [omicsonline.org]
Chronic corticosteroid therapy can lead to fluid retention and high blood pressure, some rounding of the face and softening of the bones similar to osteoporosis. [medmk.com]
Workup
X-Ray
- Gastric Fistula
Spontaneous internal gastrocolic fistulae occur as a late consequence of benign or malignant gastric ulcers ( 67 ). [ptolemy.ca]
Arioli D, Venturini I, Masetti M, Romagnoli E, Scarcelli A, et al. (2008) Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: a new variant of "Bouveret's syndrome". [graphyonline.com]
Treatment
Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances. [books.google.com]
Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. [jdeonline.in]
Successful treatment of a post-operative external biliary fistula by endoscopic papillotomy. Endoscopy 1983;15:68-9. 3. Burmeister W, Koppen MO, Wurbs D. Treatment of a biliocutaneous fistula by endoscopic insertion of a nasobiliary tube. [ijri.org]
Parenteral and enteral nutrition and the enterocutaneous fistula treatment. II. Factors influencing the outcome of treatment. Acta Chir Hung. 1991; 32 (4):305–318. [ PubMed ] [ Google Scholar ] Dorta G. [ncbi.nlm.nih.gov]
These reports have introduced a nonsurgical treatment to a disease process that has traditionally been treated surgically. [pjms.com.pk]
Prognosis
Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities. [nature.com]
Prognosis Prognosis is generally good. However, given that most patients with this condition are elderly, potential coexisting medical problems may complicate surgical intervention. [emedicine.medscape.com]
GBC is a relatively rare neoplasm which is associated with a poor prognosis, as it is often diagnosed in an advanced stage due to its nonspecific clinical presentation [24]. [graphyonline.com]
Prognosis The outcome of gastrointestinal fistulae has changed dramatically over the years with the introduction of intensive care and the provision of nutritional support. [ptolemy.ca]
Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174:331-6. 39. Matos C, Cappeliez O, Winant C, Coppens E, Devière J, Metens T. MR imaging of the pancreas: A pictorial tour. Radiographics 2002;22:e2. 40. [jdeonline.in]
Etiology
Gallstones are the primary etiologic agent in most internal biliary-enteric fistulas. [surgerysearch.blogspot.com]
Especially, chronic cholecystitis with GB stones is considered in about 75% of major etiology. Our case is also related with chronic cholecystitis. [astr.or.kr]
External biliary fistulae, in turn, can be further subdivided based on etiology into spontaneous, therapeutic, traumatic, and iatrogenic fistulae. [emedicine.medscape.com]
The etiology of biliary-enteric fistulas is yet to be clearly established. [omicsonline.org]
[…] thickness off GB wall w/ a stone in the area of the GB neck or cystic duct; edema found within the GB wall Normal wall thickness ,3mm MOST COMMON form of GB inflammation * Recurrent inflammatory changes in Gb (recurring attacks of acute cholecystitis) Etiological [quizlet.com]
Epidemiology
It's divided into three sections on anatomy, pathophysiology, and epidemiology; diagnostic and therapeutic approaches including the latest therapeutic modalities; and specific conditions. Includes more than 250 illustrations for rapid reference. [books.google.com]
Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]
Despite some epidemiological data to support this, experimental models have failed to replicate the carcinogenetic process. It is thus difficult at the present time to firmly conclude whether gallstones are the cause of GBC. [graphyonline.com]
[…] can cause chronic cholecystitis and may predispose the patient to spontaneous cholecystocutaneous fistula. [13] Polyarteritis nodosa with gallbladder vasculitis and steroid use causing immunosuppression also may be associated with the condition. [13] Epidemiology [emedicine.medscape.com]
Pathophysiology
It's divided into three sections on anatomy, pathophysiology, and epidemiology; diagnostic and therapeutic approaches including the latest therapeutic modalities; and specific conditions. Includes more than 250 illustrations for rapid reference. [books.google.com]
Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am. 1996 Oct; 76 (5):1009–1018. [ PubMed ] [ Google Scholar ] Donner CS. Pathophysiology and therapy of chronic radiation-induced injury to the colon. [ncbi.nlm.nih.gov]
Pathophysiology The cystic duct or gallbladder is almost always obstructed in patients with spontaneous cholecystocutaneous fistula. [emedicine.medscape.com]
Etiology and Pathophysiology Small intestinal fistulas can form in a number of ways. Enterocutaneous fistulas most commonly follow postoperative complications and are often the result of technical errors at the time of an abdominal procedure. [sites.google.com]
View Article PubMed Google Scholar Hernandez C, Heuman D, Vlahcevid ZR: Pathophysiology of disease associated with deficiency of bile acids. [bmcsurg.biomedcentral.com]
Prevention
CONCLUSION: Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. [ncbi.nlm.nih.gov]
On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. [books.google.com]
Conversion to open surgery should be considered early when the anatomy is not clear to prevent iatrogenic injury. [file.scirp.org]
To prevent additional complications and fatal consequences, early diagnosis and adequate treatment are essential. [kjim.org]