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KMID : 0371319690110120836
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Journal of the Korean Surgical Society
1969 Volume.11 No. 12 p.836 ~ p.839
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Sponaneous Cholecysto-gasrtic Fistula
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兪明鍾/Yoo, Myung Jong
朴成基/朴聖泰/金晋煥/Park, Sung Ki/Park, Sung Tae/Kim, Chin Whan
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Abstract
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Biliary-enteric fistula is with rare exception, a complication of long-standing and far advanced disease of biliary tract.
The majority of patients with this condition is belongs to senile group and so ofter associated with other conditions.
It is generaly accepted that, approximately 85 per cent of the cases, the etiology is a chronic diseases of bility tract associated with cholelithiasis or choledocholithiasis. The mechanism by which the fistula is established with the adjacent bowel may be briefly characterized by: necrosis of the wall, adhesion and abscess formation, and penetration of the juxtaposed viscus by the calculus.
The symptoms and disability and injury to the biliary tract and to liver that such fistulas give rise to are best treated by surgical correction.
Preoperative diagnosis of the fistula is ofter overlooked in spite of a through clinical and roentgenographic investigation, and the condition is then discovered unexpectedly at operation. The fistulas are divided into following types. 1) cholecystoduodenal fistula 2) cholcystocolic fistulas 3) cholecystogastric fistula 4) cholecystocholedochal fistula 5) choledochoduodenal fistula 6) other rare intestinal fistula.
The most frequent site of the fistula is in the area between the gallbladder and the duodenum.
A case of spontaneous cholecysto-gastnic fistula was found and treated in the Dept. of surgery, Seoul National University Hospital. It was 43 year old female who complained of nausea, vomiting, abdominal distention and pain in the entire abdomen, especially Rt. upper abdomen.
The pain was radiating to the Rt. shoulder and back and colicky in character.
Operative finding showed severe inflammatory adhesion between gallbladder, stomach and adjacent organs.
A thumb-tip siged gall stone was found between the adhested gallbladder and stomach and found a fistulous tract at the base of the gallbladder which was communicating with anterior wall of the prepylonic region of the stomach.
Cholecystostomy and primary closure of the perforated site of stomach were performed. 3 weeks later, she recieved radical operation with cholecystectomy.
Upper G-I series illustrated satisfectory passage of barium meal thereafter.
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