Consequences of Bile Duct Injury: External Biliary Fistula

Bile duct injury at cholecystectomy causes a bile leak which then results in an external biliary fistula. It could be uncontrolled, i.e., with intraperitoneal bile leak and sepsis. After drainage of peritoneal bile, it becomes a controlled fistula. The external biliary fistula following a partial bile duct injury closes in majority of the cases—some of these patients will form a benign biliary stricture. The external biliary fistula following a complete bile duct injury is less likely to close, but all these patients will require repair of the bile duct injury/benign biliary stricture. A biloma may rupture into the duodenum/colon forming an internal (bilio-enteric) fistula. Bilio-pleural, bilio-bronchial, and bilio-venous are rare internal fistulae.