Complications

The complications of a biliary fistula include:

• hyponatremia:
  • bile has a high sodium content
  • bile loss may produce a severe hyponatremia
  • hyponatraemia is more severe in an external fistula
    
    
• inanition, undernourishment and weight loss:
  • bile is an emulsifying agent and serves an important role in the absorption of fats and fat-soluble vitamins
  • malabsorption is particulary severe with external biliary fistulae
  • the resulting diarrhoea may impair protein and carbohydrate absorption
    
    
• infection:
  • bile contains coliforms and occasionally, anaerobic bacteria
  • bile leakage into body cavities causes transient bacterial infection
  • bile stasis may result in an ascending cholangitis
    
    
• gallstone ileus - only in internal fistulae