SPONTANEOUS INTERNAL CHOLEDOCHODU-ODENAL FISTULAS IN PATIENTS WITH THE MIRIZZI SYNDROME

The aim of the study. Analysis of cases of spontaneous internal peripapillary biliary fistulas in patients with Mirizzi syndrome. Materials and methods. A retrospective analysis of the data of 1500 endoscopic retrograde cholangiography per-formed in the Transcarpathian Regional Clinical Hospital for the period of 2008-2018 has been carried out. Results and discussion. The frequency of spontane-ous internal peripapillary biliary fistulas is 0.7%. Mirizzi Va-type syndrome (choledochoduodenal fistula according to the classification of Csendes) has been diagnosed in 23 patients with acute cholecystitis. The clinical picture of these patients was dominated by pain in the right hypochondrium, an increase in body temperature to 38-38.5 ºС. In the group of patients with Mirzzi Va type syndrome, choledochoduodenal fistulae were located above the terminal portion of the common bile duct at the periamapal folds proximal to the wader nipple 0.7-1.2 cm (19 cases) and outside of the periampular fold on the back wall of the duodenal bulb (DUP) (3 cases). 19 patients have undergone endoscopic papillofystulotomy for the purpose of reliable drainage of the common bile duct and pancreatic duct. Compli-cations after endoscopic manipulation did not appeare. Papilo-sphincterotomy was performed at localization of the fistula on the back of the duodenal wall. The exception was one patient, not included in the total number because it was failed to perform endoscopic pillofystulotomy due to a significant deformity of the duodenum. Conclusions. In papillary choledochoduodenal fistula, optimal tactics is endoscopic papillofystulotomy, which connects both holes in the first stage of treatment, and with suprapapillary (on the back wall of the duodenal wall) - only papilos-phincterotomy is recommended.