Diagnosis And Treatment Of Gallbladder Internal Fistula In 39 Cases

Objective: To analyze the clinical manifestations,diagnosis,treatment modalities and effectiveness of the gallbladder internal fistula,so as to guide the clinical practice.Methods: The clinical data of 39 patients with gallbladder internal fistula in the Department of Hepatobiliary of the Second Hospital Affiliated to Chongqing Medical University from January 2003 to March 2018 were analyzed retrospectively.Abdominal ultrasonography,CT,MRCP and other examinations were selected according to the condition of individual patient.The final diagnosis was based on what was seen during the operation.Individualized surgical treatment was selected for different patients.Results: A total of 39 patients with gallbladder internal fistula patients were treated in this group,including 15 males and 24 females.They are divided into 6 groups according to the type.56.4%(22/39)were diagnosed having cholecystoduodenal fistula(CDF),23.1%(9/39)having gallbladder bile duct fistula,10.3%(4/39)having cholecystogastric fistula(CGF),5.1%(2/39)having cholecystocolonic fistula(CCF),2.6%(1/39)having cholecystojejunal fistula,2.6%(1/39)having cholecystoduodenal as well as cholecystocolonic fistula.All the patients underwent surgical treatment,including 2 cases of laparoscopic surgery,and the remaining 37 cases of laparotomy operation.4 cases were definitely diagnosed preoperatively with a preoperative diagnostic rate of 10.8%.4 cases among them were attacked by postoperative complications,including 1 intestinal fistula,2 biliary fistula and 1 sepsis.2 of the 4 cases were dead and 2 recovered after symptomatic treatment.The remaining patients were cured and followed-up was not special.Conclusion: Gallbladder internal fistula is a rare complication of the biliary system.The preoperative diagnostic rate is relatively low.By inquiring the medical history detailedly and taking the examination,the diagnostic rate can be improved to a certain extent.Surgery should be taken as the first choice if possible.Perioperative management should be paid attention to and the specific operation method is decided according to the situation of the fistula in order to reduce the occurrence of postoperative complications.