Biliary fistulas are of great surgical interest because of their manifold causes, the variety of their communications, and the important problems connected with their surgical management. Two types occur, spontaneous and postoperative.
Spontaneous biliary fistulas are surgical curiosities because of the bizarre course which they may pursue. In finding an exit externally they may open at various points in the chest or abdominal wall, or even in the right thigh, but they usually open at or near the umbilicus, probably being directed to this point by the falciform ligament. Spontaneous fistulas may communicate internally with almost any part of the gastro-intestinal tract, a bronchus, the right kidney or the urinary bladder; they may even perforate the pericardium. The rarity of spontaneous biliary fistulas and their curious communications constitute their distinguishing features; they are not included in the series on which this paper is based.
A postoperative biliary fistula which continues