Aetiology
The most common cause of an internal biliary fistula is gallstone disease, accounting for 90% of cases. Peptic ulcers are the second most common factor, accounting for 5% of cases.
Less common causes include:
- duodenal ulcers: those on the posterior duodenal wall invading the common duct; those on the anterior and lateral wall invade the gallbladder
- gastric ulcers: erode into the gallbladder
- various tumours including those of the: - stomach - pancreas - common duct
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