AIR IN THE BILE PASSAGES

Abstract

Biliary fistula into the intestinal canal usually results from the combination of infection and calculi in the biliary passages. Less frequently it follows a malignant condition of the gallbladder. Seldom does it develop from a perforating duodenal ulcer. With all intra-abdominal inflammatory processes, an attempt is made by the adjacent viscera to wall off the offending structure. When suppuration of the biliary tracts occurs, adhesions form, and the gallbladder or its ducts may become agglutinated to proximate organs; i. e., duodenum, colon, stomach. As a consequence of constant pressure of calculi and advancing necrosis of the wall of the gallbladder, perforation into an adherent viscus may ensue. Internal biliary fistulas have frequently been associated with the presence of stones. Judd and Burden 1 found them to be present in the gallbladder or its ducts in 121 of their 153 cases. In 1885 Murchison 2 reported carcinoma of the gall- bladder