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文献考察１）：胆道腸管瘻(biliary enteric fistula)
Kunasani R, Rastogi V, Boonswang P, Dy VC, Van der Veer L.
Cholecystocolonic fistula presenting as massive lower GI hemorrhage.
Gastrointest Endosc. 2003 Jul;58(1):142-4. PMID: 12838245
要旨：胆道腸管瘻の90％は胆石を有する慢性胆嚢疾患と関連がある．胆嚢腸管瘻は胆嚢摘出術例の1.2〜5％に認められ，部位は十二指腸が圧倒的に多いが，10〜20％は結腸との瘻孔形成である．主な症状は腹痛，発熱，下痢と体重減少である．胆石以外の原因は消化性潰瘍，胆嚢癌（15％）と医原性または外傷によるものなど．
文献考察２）：胆道腸管瘻31例．
Int Surg. 1997 Jul-Sep;82(3):280-3.
Biliary enteric fistulas.
Atli AO, Coskun T, Ozenc A, Hersek E.
Thirty-one patients with biliary enteric fistula who were operated on over a 19-year period (1976-1994) with an incidence of 0.74% in all biliary tract operations were reviewed retrospectively to identify etiologic factors, types of fistulas, signs and symptoms, methods of diagnosis, management and prognosis of the cases. Most common symptoms were abdominal pain, nausea, vomiting and jaundice. Two patients had gallstone ileus. The majority of the patients had severe concomitant medical illnesses. The exact preoperative diagnosis of a biliary enteric fistula was established in only five (16%) patients. In 81% of the cases fistula was secondary to chronic calculous biliary tract disease. Postoperative complications included wound infection in six (19%), biliary fistula in two (6%) and erosive gastritis in one (3%) patient. Two patients died of intra-abdominal sepsis and two of cardiac failure, with an operative mortality of 13%. Early elective cholecystectomy is recommended to avoid complications of chronic calculous cholecystitis such as bilioenteric fistulas and their increased mortality and morbidity.PMID: 9372375
文献考察３）：内胆道瘻33例
HPB Surg. 1997;10(3):143-7.
The internal biliary fistula--reappraisal of incidence, type, diagnosis and management of 33 consecutive cases.
Yamashita H, Chijiiwa K, Ogawa Y, Kuroki S, Tanaka M.
To reevaluate the current features of spontaneous internal biliary fistulas, we reviewed 1,929 consecutive patients who had been treated for biliary tract diseases during the recent 12-year period. Thirty-three patients had internal biliary fistulas and the incidence was 1.9%. Of 33 patients, 20 were women and 13 were men with the average age 63 years, and their mean duration of illness was 4 years. A total of 37 fistulas were found and the most common type was choledochoduodenal (62%), followed by cholecystoduodenal (19%), cholecystocholedochal (11%) and cholecystocolonic (8%) fistulas. Internal biliary fistulas of thirty-one patients were caused by biliary stones and those of two patients by malignant tumors. All of the 17 bile samples examined were bacteria positive and the majority of calculi were brown pigment stones. All of the choledochoduodenal fistulas were correctly diagnosed by endoscopic retrograde cholangiography. In 14 patients with cholecystoenteric or cholecystocholedochal fistulas, direct evidence of the internal fistula was obtained only in 7 patients (50%) preoperatively. Pneumobilia, a small atrophic gallbladder adherent to the neighboring organs and a history of spontaneous disappearance of jaundice in elderly patients may indicate the presence of a cholecystoentric fistula. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially during laparoscopic cholecystectomy for elderly patients with cholelithiasis.PMID: 9174858
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