Cholecystocolonic fistula: facts and myths. A review of the 231 published cases

Glenn F, Reed C, Grafe WR. Biliary enteric fistula. Surg Gynecol Obstet. 1981;153:527–31.

Angrisani L, Corcione F, Tartaglia A, Tricarico A, Rendano F, Vincenti R, et al. Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery. Surg Endosc. 2001;15:1038–41.

Chowbey PK, Bandyopadhyay SK, Sharma A, Khullar R, Soni V, Baijal M. Laparoscopic management of cholecystoenteric fistulas. J Laparoendosc Adv Surg Tech A. 2006;16:467–72.

Castro AF, Ault GW, Smith RS. Cholecystocolic fistula; report of a case. Med Ann Dist Columbia. 1950;19:495–8.

Delore P, Chapuy A, Madona. Evacuation of large vesicular calculus by cholecystocolic fistula. Arch Mal Appar Dig Mal Nutr. 1950;39:740.

Michels AG, Hoerr SO. Spontaneous internal biliary fistula; a case of cholecystocolic fistula. Cleve Clin Q. 1951;18:184–9.

Lapeyre NC, Campo A, Carabalona P. Spontaneous bilio-intestinal double perforation; associated lithiasic fistulae, cholecysto-duodenal and cholecysto-colic. Montp Med. 1951;39–40:240–2.

Calihan WA, Hulbert HF. Intestinal obstruction due to gallstones; report of two cases. J Int Coll Surg. 1951;16:325–33.

Deroche R, Cabon P. Unusual case of cholecystocolic fistula. J Radiol Electrol Arch Electr Med. 1953;34:769.

Neville WE. Duodenocolic fistula due to acute cholecystitis. Am J Surg. 1953;87:300–2.

Paulini WL. Two cases of ileus due to gallstone in colon. Ned Tijdschr Geneeskd. 1953;97:1125–6.

Craighead CC, Raymond AH Jr. With special reference to choledochoduodenal fistula complicating duodenal ulcer. Am J Surg. 1954;87:523–33.

Rosenqvist H, Sjoberg SG. Duodeno-colic fistulas. Acta Chir Scand. 1955;109:293–8.

Liberti V, Garlano M. Histopathological alterations of the liver, gallbladder, pancreas, spleen and colon in cholecystocolic fistula; preliminary note. Riv Patol Clin. 1956;11:412–4.

Levrat M, Bret P, Romier H, Grivet A. Cholecystocolic fistula with cholelithiasis causing chronic diarrhea. Arch Mal Appar Dig Mal Nutr. 1957;46:879–86.

Lampe CE. Obstruction of the colon by gallstones; report of a case and analysis of 20 cases of gallstone ileus with special reference to roentgen diagnosis. Ugeskr Laeger. 1957;119:121–4.

De Keyser R. Hemorrhagic diathesis with cholecystocolic fistula. Belg Tijdschr Geneesk. 1958;14:195–7.

Eilersen P, Kjeldsen K. Steatorrhea caused by cholecystocolic fistula. Ugeskr Laeger. 1959;121:378–80.

Delannoy E, Martinot M. Choledochal lithiasis complicated by broncho-biliary and cholecysto-colic fistulae. Role of elevated pressure in the bile ducts. Lyon Chir. 1959;55:801–6.

Chaffee JS. Cholecystocolic fistula with large bowel hemorrhage. Case report. Ann Surg. 1960;152:901–4.

Young WV Jr. Gallstone ileus of the colon. Report of an unusual type of colon obstruction. Arch Surg. 1961;82:333–6.

Edmunds PK, Havard C. Duodeno-colic fistula due to gall-stones. Br J Surg. 1961;49:253–5.

Levowitz BS. Spontaneous internal biliary fistulas. Ann Surg. 1961;154:241–51.

Pasquier V. Apropos of a case of cholecystocolic fistula. Lyon Chir. 1962;58:768–70.

Hutchin P, Harrison TS, Halasz NA. Cholecystocolic fistula: a complication of cholecystostomy; with special reference to the management of cholecystostomy. Ann Surg. 1963;157:587–90.

Isherwood I, MacCaig J. Cholecysto-duodeno-colic fistula presenting with megaloblastic anaemia. Clin Radiol. 1963;14:91–3.

Dowse JL. Cholecysto-duodenocolic fistulae due to gall-stones. Br J Surg. 1963;50:776–8.

Welti H, Epfelbaum R, Gibert G. Spontaneous cholecysto-colic biliary fistula: cataclysmic hemorrhage from ulceration of the cystic artery. Mem Acad Chir (Paris). 1964;90:932–5.

Zisk J, Furman GN, Morgenstern L. Massive rectal bleeding from a cholecystocolic fistula. Calif Med. 1964;100:370–1.

Lauras H. Pseudo-cancerous cholecysto-colic fistula with profuse hemorrhage. Mem Acad Chir (Paris). 1965;91:271–2.

Bastien J, Hartglas L. A case of cholecystocolic fistula with cataclysmic hemorrhage. Mem Acad Chir (Paris). 1965;91:541–4.

Elsas LJ, Gilat T. Cholecystocolonic fistula with malabsorption. Ann Intern Med. 1965;63:481–6.

Pedersen SN. Cholecysto-duodeno-colic fistula. Report of a case. Acta Chir Scand. 1965;129:452–6.

Stanciu G. Radiologic study of a cholecystocolic fistula. J Radiol Electrol Med Nucl. 1966;47:427–8.

Nemhauser GM, Thompson JC. Cholecystoduodenocolic fistula due to gallstones: case report. Ann Surg. 1966;163:81–5.

Kaplan BJ. Massive lower gastrointestinal hemorrhage from cholecystocolic fistula. Dis Colon Rectum. 1967;10:191–6.

Gudas PP Jr, Haberman GC, Belcher HV. Cholecystocolonic fistula. Arch Surg. 1967;95:228–9.

Hureau J, Bourdais JP, Vayre P, Levasseur JC. A case of duodeno-cholecysto-colic fistula of lithiasic origin. Sem Hop. 1968;44:1979–81.

Birnbaum JJ, Tolins SH. Cholecystoduodenal and cholecystocolonic fistula: report of a case and review of the literature. Mt Sinai J Med. 1970;37:625–31.

Augur NA Jr, Gracie WA Jr. Cholecystocolonic fistula associated with malabsorption. Am J Gastroenterol. 1970;53:558–63.

Shocket E, Evans J, Jonas S. Cholecysto-duodeno-colic fistula with gallstone ileus. Arch Surg. 1970;101:523–6.

Grossman ET. Cholecystocolic-fistula—an unusual cause of diarrhoea. Am J Gastroenterol. 1971;55:277–83.

Ianacone JA, Becker GL Sr. Diagnosis of a cholecystocolic fistula by sigmoidoscopy and serendipity. J Med Soc N J. 1971;68:215–8.

Menda RK, Chulani HL. Cholecystocolonic fistula following ameboma of the ascending colon: report of a case. Dis Colon Rectum. 1971;14:386–8.

Wise WS, Caldwell FT. Cholecystoduodenocolic fistula. Am J Surg. 1971;121:349–50.

Piedad OH, Walczak PM. Cholecystogastrocolic fistula. N Y State J Med. 1972;72:388–9.

Aznar Reig A. Spontaneous disappearance of a large biliary calculus. Biliary-colic fistula. Rev Esp Enferm Apar Dig. 1973;41:255–66.

Safaie-Shirazi S, Zike WL, Printen KJ. Spontaneous enterobiliary fistulas. Surg Gynecol Obstet. 1973;137:769–72.

Godquin B, Favre R, Blanchard J, Boutovitch N. A cholecysto-colic fistula caused by perforation of a gallbladder cancer. Case report. Acta Gastroenterol Belg. 1974;37:236–42.

Balsano NA, Reynolds BM. Cholecystocolic fistula with colonic obstruction: report of a case. Dis Colon Rectum. 1974;17:766–8.

Olteanu C, Socoteanu I. Gallbladder lithiasis complicated by a cholecystocolonic fistula and digestive haemorrhage. Chirurgia (Bucur). 1974;23:141–4.

Doromal NM, Estacio R, Sherman H. Cholecysto-duodeno-colic fistula with gallstone ileus: report of a case. Dis Colon Rectum. 1975;18:702–5.

Marsault C, Drouard F, Gaussin G. A rare case of double biliary fistula. J Radiol Electrol Med Nucl. 1977;58:657–8.

Zaw-win B, Darwish M, Dibos PE, Razzak IA. I131–rose bengal scanning in the detection of cholecystocolic fistula. New use of an established procedure. Am J Gastroenterol. 1977;68:396–8.

Mrozowski A, Malinowski S. Preoperatively diagnosed cholecystocolonic fistula. Pol Tyg Lek. 1977;32:537–8.

Raya Munoz J, Gil Extremera B, Garcia Romero E, Salmeron Escobar J, Sanchez Alcala B. A case of pyloric stenosis caused by biliary calculi and a double biliary-duodenal and biliary-colonic fistula. Rev Esp Enferm Apar Dig. 1977;51:211–8.

Morris SJ, Greenwald RA, Barkin JS, Tedesco FJ, Snyder R. Cholecystoduodenocolic fistula secondary to carcinoma of the gallbladder. Am J Dig Dis. 1978;23:849–52.

Hricak H, Vander Molen RL. The radiology corner: duodenocolonic fistula with gallstone ileus. Am J Gastroenterol. 1978;69:711–5.

Faintuch J, Martini AC, Machado MC, Raia AA. Clinico-surgical repercussions of cholecystocolic fistula. Rev Hosp Clin Fac Med Sao Paulo. 1979;34:289–93.

Rau WS, Matern S, Gerok W, Wenz W. Spontaneous cholecystocolonic fistula: a model situation for bile acid diarrhoea and fatty acid diarrhoea as a consequence of a disturbed enterohepatic circulation of bile acids. Hepatogastroenterology. 1980;27:231–7.

Ritchie AW, Crucioli V. Double gallbladder with cholecystocolic fistula: a case report. Br J Surg. 1980;67:145–6.

Edell SL, Milunsky C, Garren L. Cholescintigraphic diagnosis of cholecystocolic fistula. Clin Nucl Med. 1981;6:303–4.

Anseline P. Colonic gall-stone ileus. Postgrad Med J. 1981;57:62–5.

Griffith CD, Saunders JH. Cholecystoduodenocolic fistula following abdominal trauma. Br J Surg. 1982;69:99–100.

Bates GJ, Askew AR. Cholecystocolic fistula in a young woman. Med J Aust. 1983;2:11–2.

White M, Simeone JF, Muller PR. Imaging of cholecystocolic fistulas. J Ultrasound Med. 1983;2:181–5.

Mittelstaedt WE, Carone Filho E, Sekini JH, Deutsch CR, Neri JR, Pires PW, et al. Bilio-digestive fistulas. Arq Gastroenterol. 1984;21:3–12.

Pangan JC, Estrada R, Rosales R. Cholecystoduodenocolic fistula with recurrent gallstone ileus. Arch Surg. 1984;119:1201–3.

Gibbons CP, Ross B. Cholecystoduodenocolic fistula and gallstone ileus. Postgrad Med J. 1984;60:698–9.

Jensen LS, Falstie-Jensen S. Gallstone-induced colonic ileus. Ugeskr Laeger. 1984;146:2706.

Takada T, Yasuda H, Uchiyama K, Hasegawa H, Kuniyasu Y, Higashi S, et al. A case of cholecystocolic fistula demonstrated with 99mTc-PMT imaging. Rinsho Hoshasen. 1985;30:617–20.

Ripley SD, Fink-Bennett D. Enterobiliary fistulae: a potential cause of a false-negative hepatobiliary study in the diagnosis of acute cholecystitis. Eur J Nucl Med. 1985;10:167–8.

Milsom JW, MacKeigan JM. Gallstone obstruction of the colon. Report of two cases and review of management. Dis Colon Rectum. 1985;28:367–70.

Rosenberg RJ, Sziklas JJ, Spencer RP, Mathews J. Gallbladder to colon fistula demonstrated on hepatobiliary study. Clin Nucl Med. 1985;10:727.

Deitz DM, Standage BA, Pinson CW, McConnell DB, Krippaehne WW. Improving the outcome in gallstone ileus. Am J Surg. 1986;151:572–6.

Van Gossum M, Fastrez R, Issa S, Burette A, Nyst JF, Deltenre M. Cholecystoduodenocolic fistula and gallstone ileus. Acta Gastroenterol Belg. 1986;49:624–7.

Colovic R, Dordevic D, Colovic M. Cholecysto-colonic fistula (2 case reports). Acta Chir Iugosl. 1987;34:160–6.

Lautatzis M, Shoenut JP, Scurrah J, Micflikier AB. Pseudocalculus of the common bile duct. Can J Surg. 1988;31:37–8.

Mishra GK, Vernekar J, Pandey M, Gupta A. Fatty diarrhoea due to spontaneous cholecystocolonic fistula. J Assoc Physicians India. 1988;36:176–7.

Goldberg RI, Phillips RS, Barkin JS. Spontaneous cholecystocolonic fistula treated by endoscopic sphincterotomy. Gastrointest Endosc. 1988;34:55–6.

Giglio P, Cossavella D, Bosco L. A rare case of spontaneous cholecysto-choledocho-duodenocolic fistula. Minerva Chir. 1988;43:721–3.

Caramanico L, Gianferro A, Occhigrossi G, Costi U, Izzo L, Smaldone W. Biliary ileus located in the sigmoid. Minerva Chir. 1988;43:1631–4.

Patel SA, Engel JJ, Fine MS. Role of colonoscopy in gallstone ileus—a case report. Endoscopy. 1989;21:291–2.

Tubia Landaberea JI, Palomar LM, Cormenzana Lizarribar E, Beguiristain Gomez A, Rocandio Cilveti E, Alvarez Caperochipi J. Spontaneous cholecystocolonic fistulas. Presentation of 5 cases. Rev Esp Enferm Apar Dig. 1989;75:192–7.

Kadyrov ZL. Cholelithiasis complicated by cholecysto-colonic fistula. Vestn Khir Im I I Grek. 1989;142:7.

Chaikovskii IuIa, Kornev VM, Sharov NA, I’lin SV. Cholecysto-colonic fistula as a complication of cholelithiasis. Vestn Khir Im I I Grek. 1989;142:6.

Lim BH, Mack P, Mohan C. Cholecysto-duodeno-colic fistula—a case report. Ann Acad Med Singapore. 1989;18:296–7.

Braun L. Gallstone ileus. Incidence, clinical aspects, therapy. Chirurg. 1989;60:545–8.

Serrano R, Montanana A, Lacasa J. Cholelithiasis and cholecysto-colonic fistula: a rare form of biliary ileus. Rev Esp Enferm Dig. 1990;77:55–7.

Sing RF, Garberman SF, Frankel AM, Chatzinoff M. Cholecystocolic fistula: an unusual presentation and diagnosis by endoscopic retrograde cholangiopancreatography. Surg Endosc. 1990;4:39–40.

Caroli-Bosc FX, Ferrero JM, Grimaldi C, Dumas R, Arpurt JP, Delmont J. Cholecystocolic fistula: from symptoms to diagnosis. Gastroenterol Clin Biol. 1990;14:767–70.

Benage D, O’Connor KW. Cholecystocolonic fistula: malabsorptive consequences of lost bile acids. J Clin Gastroenterol. 1990;12:192–4.

Leong S. Cholecysto-duodenocolic fistula—a case report. Ann Acad Med Singapore. 1990;19:421.

Sakurai Y, Itoh M, Tsuchiya H, Ikegami F, Takasu S, Izumi T, et al. Acute cholecystocolic fistula detected by colonoscopy. Gastrointest Endosc. 1990;36:163–4.

Clavien PA, Richon J, Burgan S, Rohner A. Gallstone ileus. Br J Surg. 1990;77:737–42.

Roberts SR, Chang C, Chapman T, Koontz PG Jr, Early GL. Colonoscopic removal of a gallstone obstructing the sigmoid colon. J Tenn Med Assoc. 1990;83:18–9.

Miguil M, Abassi O, Margad B, Harti A, Benslama A, Benaguida M. Severe hemobilia of cholecystic origin. J Chir (Paris). 1991;128:83–5.

Catalano O. Echographic nonvisualization of the gallbladder in a case of cholecysto-colic fistula. Radiol Med (Torino). 1992;84:489–90.

Rosell Pradas J, Andujar Sanchez M, Martin Ruiz JL, Mantas Avila JA, Morales Valentin OI, Guerrero Fernandez-Marcote JA, et al. Xanthogranulomatous cholecystitis. Rev Esp Enferm Dig. 1992;82:334–8.

Wagtmans M, Kooy M, Snel P. Persistent diarrhoea in cholecystocolic and gastrocolic fistula after gastric surgery. Neth J Med. 1993;43:218–21.

Gerst PH, Katter H, Rosario PG. Cholecystocolic fistula masquerading as colon cancer. Am J Gastroenterol. 1993;88:1296–7.

Catalano O, Rotondo A. Biliary ileus of the sigmoid: its echographic diagnosis. A case report. Radiol Med (Torino). 1994;87:519–20.

Swinnen L, Sainte T. Colonic gallstone ileus. J Belge Radiol. 1994;77:272–4.

Prasad A, Foley RJ. Laparoscopic management of cholecystocolic fistula. Br J Surg. 1994;81:1789–90.

Anez LF, Gupta SM. Cholescintigraphy detection of cholecystocolonic fistula and liver abscess. Clin Nucl Med. 1994;19:551–2.

Figarella J, Campan P, Lecoq C. A case of biliary ileus of the colon. J Chir (Paris). 1994;131:330–1.

Gentileschi P, Forlini A, Rossi P, Bacaro D, Zoffoli M, Gentileschi E. Laparoscopic approach to cholecystocolic fistula: report of a case. J Laparoendosc Surg. 1995;5:413–7.

Seto H, Watanabe N, Kageyama M, Shimizu M, Nagayoshi T, Kamisaki Y, et al. Concurrent detection of cholecystocolic fistula and hepatic abscess by hepatobiliary scintigraphy. Ann Nucl Med. 1995;9:93–5.

Williams J, Deans G, Royston C, Brough W. Laparoscopic management of cholecystocolic fistula. Br J Surg. 1995;82:565.

Ibrahim IM, Wolodiger F, Saber AA, Dennery B. Treatment of cholecystocolonic fistula by laparoscopy. Surg Endosc. 1995;9:728–9.

Khaira HS, Awad RW, Thompson AK. Squamous cell carcinoma of the gallbladder presenting with a biliary-colic fistula. Eur J Surg Oncol. 1995;21:581–2.

Hession PR, Rawlinson J, Hall JR, Keating JP, Guyer PB. The clinical and radiological features of cholecystocolic fistulae. Br J Radiol. 1996;69:804–9.

Perez Morera A, Perez Diaz D, Calvo Serrano M, de Fuenmayor Valera ML, Martin Merino R, Turegano Fuentes F, et al. Acute obstruction of the colon secondary to biliary lithiasis. Rev Esp Enferm Dig. 1996;88:805–8.

Pianalto S, Rossi M, Battaglia G, Pizzato D, Ancona E. Cholecysto-colic fistula: laparoscopic treatment. Ann Ital Chir. 1997;68:231–3.

Sirakov M, Trichkov V, Megdanski KH. Spontaneous internal biliary fistulae—a report of 4 clinical cases. Khirurgiia (Sofiia). 1997;50:16–8.

Yamashita H, Chijiiwa K, Ogawa Y, Kuroki S, Tanaka M. The internal biliary fistula—reappraisal of incidence, type, diagnosis and management of 33 consecutive cases. HPB Surg. 1997;10:143–7.

Foster DR. Colonic gallstone ileus. Australas Radiol. 1997;41:76–7.

Hakim M, Boyd R, Stricoff R, Shaftan G, Saxe A. Cholecystogastrocolonic fistula with intrahepatic abscess: a rare complication of biliary stone disease. Am Surg. 1997;63:472–4.

Andersen PS, Petersen JK. Colonic ileus caused by a giant gallstone. Ugeskr Laeger. 1998;160:4653–4.

Bornet G, Chiavassa H, Galy-Fourcade D, Jarlaud T, Sans N, Labbe F, et al. Biliary colonic ileus: an unusual cause of colonic obstruction. J Radiol. 1998;79:1499–502.

Reddy KM, Fiennes AG. Cholecystocolic fistula at laparoscopic cholecystectomy: primary closure and laparoscopic caecostomy. Surg Laparosc Endosc. 1998;8:400–1.

Hida Y, Morita T, Fujita M, Miyasaka Y, Katoh H. Laparoscopic treatment of cholecystocolonic fistula: report of a case preoperatively diagnosed by barium enema. Surg Laparosc Endosc Percutan Tech. 1999;9:217–9.

Kuo KK, Sheen PC, Chang SC, Chen JS, Lee KT, Cham CM. Spontaneous multiple cholecystoenteric fistulas—a case report. Kaohsiung J Med Sci. 1999;15:674–8.

Goenka P, Iqbal M, Manalo G, Youngberg GA, Thomas E. Colo-cholecystic fistula: an unusual complication of colonic diverticular disease. Am J Gastroenterol. 1999;94:2558–60.

Buła G, Niemiec A, Podwińska E. Low obturation ileus caused by gallstone incarceration in sigmoid colon. Wiad Lek. 1999;52:413–6.

Stagnitti F, Mongardini M, Schillaci F, Dall’Olio D, De Pascalis M, Natalini E. Spontaneous biliodigestive fistulae. The clinical considerations, surgical treatment and complications. G Chir. 2000;21:110–7.

Martin I, Siriwardena A. Safe laparoscopic cholecystectomy in the presence of a cholecysto-enteric fistula. Dig Surg. 2000;17:178–80.

Tocchi A, Mazzoni G, Miccini M, Puma F, Giuliani A. Acquired abnormalities of the biliary tract. Preoperative diagnosis and surgical risk in the laparoscopic era. G Chir. 2001;22:18–21.

Fujitani K, Hasuike Y, Tsujinaka T, Mishima H, Takeda Y, Shin E, et al. New technique of laparoscopic-assisted excision of a cholecystocolic fistula: report of a case. Surg Today. 2001;31:740–2.

Sam JW, Ghesani N, Alavi A, Rubesin SE, Birnbaum BA. The importance of morphine-augmented cholescintigraphy for the diagnosis of a subtle cholecystocolic fistula. Clin Nucl Med. 2001;26:552–4.

Ahn SI, Hong KC, Hur YS, Lee KY, Kim SJ, Seo JM, et al. Cholecystocolic fistula caused by blunt trauma. Injury. 2001;32:341–2.

Moreno Ruiz FJ, del Rey Moreno A, Suescun Garcia RM, Martinez Ferriz JA, Hidalgo Garrido JM, Espadas Padial B, et al. Treatment of cholecystoduodenal fistula in the era of laparoscopy. Rev Esp Enferm Dig. 2001;93:715–20.

Maltz C, Zimmerman JS, Purow DB. Gallstone impaction in the colon as a result of a biliary-colonic fistula. Gastrointest Endosc. 2001;53:776.

Benson AJ, Reinschmidt J, Billingsley JL, Timmons JH, Parish GH. Biliary-colonic fistula diagnosed via hepatobiliary scintigraphy. Clin Nucl Med. 2001;26:150–1.

Tantia O, Bandyopadhyay SK, Sen B, Khanna S. Pericholecystic fistula: a study of 64 cases. Int Surg. 2002;87:90–93.

Dutta U, Nagi B, Kumar A, Vaiphei K, Wig JD, Singh K. Pneumobilia—clue to an unusual cause of diarrhea. Trop Gastroenterol. 2002;23:138–40.

De Keuleneer R, Maassarani F, Lallemand B. Mirizzi syndrome with a double biliary fistula. Acta Chir Belg. 2002;102:345–7.

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Velayos Jimenez B, Gonzalo Molina MA, Carbonero Diaz P, Diaz Gutierrez F, Gracia Madrid A, Hernandez Hernandez JM. Cholecystocolic fistula demonstrated by barium enema: an uncommon cause of chronic diarrhoea. Rev Esp Enferm Dig. 2003;95:811–2.

Pavlidis TE, Atmatzidis KS, Papaziogas BT, Papaziogas TB. Management of gallstone ileus. J Hepatobiliary Pancreat Surg. 2003;10:299–302.

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Singh AK, Gervais D, Mueller P. Cholecystocolonic fistula: serial CT imaging features. Emerg Radiol. 2004;10:301–2.

Sipos P, Szabo S, Ondrejka P, Hermann C, Elek G, Sugar I. Subtotal colectomy in the course of gallstone-ileus surgery. Magy Seb. 2004;57:293–6.

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Perez-Morales A, Roesch-Dietlen F, Diaz-Blanco F, Martinez-Fernandez S. Safety of laparoscopic cholecystectomy in complicated vesicular disease. Cir Cir. 2005;73:15–8.

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