An internal biliary fistula is an established and abnormal connection between the biliary tree and an internal structure. They often follow peptic ulcer, gallstone disease and cancer. They have an insidious presentation since the antecedent inflammatory or neoplastic adherence to another body structure occurs over a protracted period of time. The existence of an internal fistula is often evident on plain X-ray, which may show air in the biliary tract.
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