The presence of air or barium in the biliary tract indicates either an internal biliary fistula or regurgitation through an incompetent sphincter of Oddi. The finding of air in the biliary tract assumes special significance in the presence of small-bowel obstruction. In such a case the diagnosis of gallstone ileus is very strongly suggested, even though no calculus is visible. Within the past year we have seen six patients who had either air or barium in the biliary tract. One patient had a cholecytocolic fistula, one had a cholecystoduodenal fistula; in one patient there was regurgitation through an incompetent sphincter of Oddi secondary to a chronic pancreatitis, in two cases the cause was not determined anatomically, and in one patient a cholecystojejunostomy had been performed one year previously for carcinoma of the ampulla of Vater.
Incidence, Etiology, and Significance
Spontaneous internal biliary fistulas are among the least common complications of