TWO CASES OF CHOLECYSTODUODENAL FISTULA

This paper describes two cases of cholecystoduodenal fistula diagnosed preoperatively. Case 1: A 68-year-old woman was admitted to the hospital because of nausea, fever and general fatigue, which developed during treatments for diabetes and mild hyperternsion. A plain X-ray film of the abdomen, Ultrasonographic examination (US), and computed tomography (CT) showed the presence of free air within the biliary system. Upper gastrointestinal series and gastric endoscopic fistulography revealed cholecysto-duodenal fistula and choledocholithiasis. Case 2: A 52-year-old man was admitted to the hospital because of abdominal pain, fever and jaundice. The patient was found to have a pneumobilia on US and CT. A cholecystogastric fistula was recognized by gastric endoscopic fistulography, but choledocholithiasis was not recognized. At surgery, closing of cholecysto-duodenal fistula, cholecystectomy, incision of the common bile duct and insertion of a T-tube were carried out. These fistulas were comprized of inflammatory changes, which might be an internal biliary fistula due to cholecystitis. These patients are presently going well without any complaints. During a past one decade 216 cases of idiopathic internal biliary fistula have been reported in the Japanese literature. Cholecystitis represents 85-90% of all underlying diseases for this disease, and cholecystoduodenal fistula occurs in a frequency of 50-60%.