Clinical features

The clinical features of a biliary fistula include:

• biliary peritonitis - caused by leakage of bile into the peritoneal cavity. It is associated with an elevated conjugated serum bilirubin, due to absorption of bile from the peritoneal cavity, and later, with an elevated serum alkaline phosphatase, probably due to pericholangitis

Usually, there is:

• fever
• abdominal tenderness

Rarely, the peritonitis is more indolent. There is:

• mild jaundice }
• abdominal distension } bile ascites

There is also likely to be cholangitis.