Spontaneous Internal Biliary Fistulae.

The gall bladder lies on the under surface of the liver, and is held in position by areolar tissue and the peritoneum covering the under surface of the liver. It lies obliquely, its long axis being directed backwards and upwards and slightly medially from the lower anterior edge of the liver, to the right end of the porta hepatis. The fundus of the gall bladder is in close relation to the anterior abdominal wall. The transverse colon is closely related to the inferior surface of the fundus and body of the gall bladder, and the pylorus and first part of the duodenum lie below the neck of the gall bladder and cystic duct. The common bile duct descends in the free margin of the lesser omentum, passing behind the first part of the duodenum, to enter a groove in the head of the pancreas and open into the second part of the duodenum (Fig. 1). It is not surprising, therefore, that spontaneous internal biliary fistulae are most likely to form between the gall bladder and the first part of the duodenum (or pylorus) and the colon, and also between the common bile duct and the first part of the duodenum (or pylorus). Occasionally adjacent viscera are connected by multiple fistulae