Author(s): Shimono T, Nishimura K, Hayakawa K
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Abstract BACKGROUND: To define the signs useful for differentiating between gallbladder-enteric fistula (GB-EF) and common bile duct-enteric fistula (CBD-EF) on computed tomography (CT) because the prognosis and management of the two are different. METHODS: CT scans in 13 patients with pneumobilia, who had not had surgical biliary-enteric anastomosis and endoscopic sphincterotomy, were reviewed. The presence of fistula itself, the location of air in the biliary system, and the appearance of the gallbladder were assessed. RESULTS: The causes of pneumobilia were GB-EF in seven patients, CBD-EF in three patients, emphysematous cholecystitis (EC) in one patient, gallbladder cancer (GBC) in one patient, and incompetent sphincter of Oddi in one patient. In three of seven GB-EF patients (43\%) and in none of the three CBD-EF patients (0\%), the fistula itself was detected. Air was detected in the common bile duct in four of seven GB-EF (57\%) and in all three CBD-EF (100\%) patients, and GBC. In six of seven GB-EF (86\%) and in one of three CBD-EF (33\%) patients, the gallbladder was contracted. Thus, the location of air and the contraction of gallbladder were useful signs to differentiate GB-EF from CBD-EF. CONCLUSION: CT can distinguish between GB-EF and CBD-EF.
This article was published in Abdom Imaging
and referenced in Journal of Gastrointestinal & Digestive System