Fístulas biliodigestivas litiásicas (a propósito de 3 casos clínicos)

ResumoAs fístulas biliodigestivas espontâneas são pouco frequentes. Reportamos 3 casos.Caso 1Homem de 59 anos, com história de coledocolitíase, recorreu ao serviço de urgência, por dor abdominal, hematoquézias e palidez. Tinha Hb de 8,4 g/dl. A colonoscopia e a endoscopia digestiva alta foram normais. Foi feita hemotransfusão e teve alta. Passados 18 dias voltou ao Serviço de Urgência com quadro semelhante. Repetiu-se a colonoscopia que foi normal. Após hemotransfusão e estabilização, teve alta. Seis dias depois voltou novamente à Urgência. A colonoscopia revelou coágulo aderente ao ângulo hepático. Ainda internado, teve 2 episódios de hematoquézias volumosas. Foi operado de urgência. No intra-operatório, verificou-se que o doente tinha uma fístula colecistocólica, litíase vesicular e hemobilia.Caso 2Homem de 74 anos, internado por hemorragia digestiva, com melenas e anemia com Hb de 9,7 g/dl. A endoscopia digestiva alta revelou sufusões hemorrágicas gástricas e bulbares com sangue no estômago e no duodeno. Na colonoscopia observaram-se apenas pregas edemaciadas no ângulo esplénico, tendo o doente tido alta hospitalar. Cerca de 45 dias depois da alta, recorre ao Serviço de Urgência com sensação de obstrução reto-anal. O toque retal evidenciou a presença de um objeto pétreo no reto, tendo este sido retirado manualmente. Tratava-se de um volumoso cálculo biliar.Caso 3Homem de 75 anos, enviado para realização de CPRE por iterícia obstrutiva e deformação bulbar. Estava itérico. A TAC mostrava dilatação das vias biliares intra e extra-hepáticas e aerobilia. A CPRE demonstrou a presença de um orifício fistuloso duodenal acima da papila drenando bílis e a presença de pequeno cálculo a jusante do orifício.ConclusãoTratou-se de 3 casos de fístulas biliodigestivas secundárias a litíase biliar.

Spontaneous bilio-digestive fistulae are infrequent. We report three cases.Case 1A 59 year old male, was admitted to the Emergency Department with complaints of abdominal pain, hematoquesia and pallor. The haemoglobin was 8.4 g/dl. Colonoscopy and upper gastrointestinal endoscopy were normal. He was given blood transfusion and subsequently discharged. Eighteen days later, he was readmitted to the Emergency Department with the same complaints. The exams were normal and after a transfusion, he was discharged. He was again admitted to the Emergency Department after six days. During his hospitalization he had two episodes of hematoquesia. The colonoscopy revealed a blood clot in the hepatic angle. An urgent surgery was made and revealed a cholecistocolonic fistulae, vesicular lithiasis and hemobilia.Case 2A 74 year old male was admitted with to the Emergency Department with a history of melenas with a Hb of 9.7 g/dl. The upper gastrointestinal endoscopy revealed gastric and duodenal erosions and blood. The colonoscopy showed edematous and congested mucosal folds the splenic angle of the descending colon. He was given blood transfusions and subsequently discharged. Nearly 45 days later, the patient presented to the Emergency Department complaining of difficulty in evacuating stools. The proctologic examination revealed a petrous object in the rectum which was manually removed under anesthesia. The object was a large billiary stone.Case 3A 75 year old male, with obstructive jaundice and bulbar deformation was admitted to the hospital for an ERCP. The CT had revealed a dilatation of intra and extra hepatic biliary tree and aerobilia. During the ERCP, just above the papilla, a small orifice draining bile was observed along with a calculus at the end of the choledocus.ConclusionsIt were 3 cases of biliodigestive fistulas secondary to gallstones.