Mucoclasis was performed and cholecystoduodenal fistula was closed. After partial cholecystectomy, a closure of a cuff of gallbladder wall was performed over a Nélation's tube placed into the cholecystohepatic fistula. Patient was discharged on 69th postoperative day after recovery. The type with these two fistulae is a extremely rare case according to review of the literature on spontaneous internal biliary fistula in Japan.
Sixty-nine year-old female was hospitalized with hypertension, trigeminal neuralgia and dullness of the right hypochondrium. Pneumobilia was found by plain abdominal X-ray film. Examinations by duodenal fiberscope with cholangiography revealed the coexistence of a cholecystoduodenal fistula with a cholecystohepatic fistula. Operative procedure was performed; the gallbladder was shrunk (3×3.5cm) and dissected. Findings were two fistulae, a cholecystoduodenal fistula, 8mm in diameter and a cholecystohepatic fistula, 5mm in diameter.