Abstract:Objective:To analyze the causes and prevention measures of missed diagnosis of internal biliary fistula. Methods :A retrospective analysis of the clinical data of 32 patients with missed diagnosis of internal biliary fistula was made. Their mean age was 52.1(range 25~72)years. Ultrasonography, T tube cholangiography, upper gastrointestinal endoscopy and bariums meal examination, choledochofiberscopy, ERCP, and PTC were taken in these patients. All of the patients were treated by open laparotomy. Results:Among 44 cases with internal biliary fistula ,the preoperative missed diagnosis rate was 72.73%(32/44cases), and all of the 32cases were correctly diagnosed during operation. Conclusions:The preoperative missed diagnosis rate of internal biliary fistula was high. Awareness of internal biliary fistula must be heightened. Clinical features, history and laboratory evidence characteristic of the disease must be sought preoperatively. When biliary pneumatosis is shown on ultrasonography, endoscopy and visualization must be done. These are reliable methods in preoperative diagnosis of internal biliary fistula.