Vesicular-digestive fistulas in cholelithiasis with concomitant pancreatitis

Abstract

Aim — evaluation of the incidence of pressure ulcers and vesicular-digestive fistulas in cholecystolithiasis, concomitant chronic pancreatitis, as well as the incidence and effectiveness of basic diagnostic studies of gallstone small bowel obstruction in these patients.
 Materials and methods. Over the past 10 years, we have analyzed 5055 cholecystectomies in the surgical department No 2 of the Kuzbass Clinical Emergency Hospital n. a. M. A. Podgorbunsky. In terms of anamnesis, 509 people in this group were treated for chronic pancreatitis, 116 had diabetes mellitus. We have analyzed the surgical treatment of 1086 patients with acute mechanical intestinal obstruction in the surgical department No 1 from 1997 to 2020, gallstone ileus was in 4 operated.
 Results. At 5055 cholecystectomies, 10 (0.19%) cases of biliodigestive fistulas were found, including 4 (0.08%) vesicular-duodenal and 6 (0.12%) vesicular-colonic fistulas. In 3 cases, patients underwent long-term treatment for chronic pancreatitis, one patient suffered from diabetes mellitus. Cholecystectomy was successfully combined with bowel suturing. Among 1086 patients, urgently operated on with mechanical intestinal obstruction, gallstone ileus was detected in 4 patients (0.37%). Convincing indications for surgical treatment were vomiting and paretic expansion of the initial sections of the small intestine with a delay in the advancement of barium suspension during its contrasting. Enterotomy and lithoextraction were performed in elderly patients.
 Conclusion. Vesicular-duodenal fistulas are formed in 0.08% of cases upon long-term cholecystolithiasis, surgeons detect vesicular-colonic fistulas in 0.12% during cholecystectomy. 30% of these patients received treatment for chronic pancreatitis. Cholelithiasis small bowel obstruction occurs in 0.37% of those operated on with mechanical intestinal obstruction. Diagnostic difficulties do not arise upon using radiation methods of examination.