SPONTANEOUS internal biliary fistula is not an uncommon complication of neglected cholelithiasis, peptic ulcers, and carcinoma. The incidence, as given by various authors.1 differs but seems to vary between 3 and 5% of all cases of biliary disease. During the past three years there have been 60 patients with disorders of the biliary tract at this hospital who either have been operated on or have come to autopsy. Of these, there have been two with internal biliary fistula, due to peptic ulcer in both.
Hicken and Coray1b state that 90% of biliary fistulas are caused by cholelithiasis and 6% are due to perforation of a peptic ulcer eroding into another viscus. The remaining 4% are due to carcinoma.An internal biliary fistula, once established, generally remains open until the cause has been removed. Not only may the original fistula remain, but additional fistulas between other organs occasionally