Abstract

Fistulas of the biliary tract are infrequent but serious complications of biliary tract disease. The diagnosis of external fistulas is easy, but internal fistulas, when there has been no previous surgery, may be unsuspected because characteristic symptoms are lacking. Internal fistulas may be visible within the biliary tree in plain roentgenograms; they may become visible by reflux of barium from the gastrointestinal tract into the bile ducts; or they may be recognized by the finding of a characteristic frothy excretion pattern within the liver after intravenous cholangiography with methylglucamine iodipamide. This finding is here reported for the first time in connection with 9 cases of roentgenologically diagnosed spontaneous internal biliary fistulas.

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