Biliary Fistula: An Analysis of Two Case Reports with Review of Literature

Abstract

Biliary fistulas are entities whose etiology can be diverse ranging from iatrogenic to infectious. The site of origin of fistula can be from small biliary radicals to larger biliary ducts. Surgical treatment of fistulas are often difficult owing to small size of radicals and sectoral biliary ducts and many a time the location of the injury is high up in the hilum. Aim: The present case studies of two patients aim to discuss the management of persistent biliary fistula resulting from infectious liver disease. Presentations of Case: The two cases discussed pertain to biliary fistula. In case A the fistulous tract developed post operatively after drainage of amebic liver abscess. In case B bile stained cystic fluid was noted intraoperatively. Discussion: Biliary fistulas are described as persistent biliary leakage for more than 10 days. They can arise due to injury to bile duct during cholecystectomy, hepatic trauma, hydatid cyst or liver abscess. Endoscopic sphincterotomy with stenting allowed the defect to heal at a hastened pace. Conclusion: Despite a varied etiology of biliary fistulae, diversion of biliary flow from fistulous site via endoscopic procedure is a safe and effective method.