Rare Presentation of Gallstone Ileus with One Stage Laparoscopic Management; the Tragedy, the Comedy and the Solution. Case Report

Introduction: Gallstone ileus is one of the rare complications of gallbladder stones and is a comparatively unique trigger of alimentary tract obstruction. It involves the development of a cholecystoenteric fistula through which a gallstone has passed into the gastrointestinal tract. Spontaneous resolution of intestinal obstruction in gallstone ileus is extremely rare.Case presentation: We present a case of a 71-year-old female patient presented by right hypochondrial pain for 4 months. Patient gave history of absolute constipation and abdominal distention 2 months before presentation that lasted for 3 days and resolved spontaneously. Imaging showed gallbladder stone and pneumobilia. Laparoscopic exploration showed a cholecysto-duodenal fistula that was divided, opening in the first part duodenum was closed directly in double layers and cholecystectomy was completed successfully.Conclusion:Presence on pneumobilia in patient with gallstones should raise suspicion of fistula between biliary tree and gut. Obstruction component of gallstone ileus can resolve spontaneously in rare occasions. Single stage laparoscopic management of cholecysto-duodenal fistula is safe and feasible in presence of experienced HPB laparoscopic surgeon.

Laparoscopic management of rare “ H type” duplication of gall bladder

A duplicated gallbladder is a rare congenital anomaly with an incidence of 1:4000 live births. Theycan remain asymptomatic and identified incidentally or present as acute cholecystitis, empyema,torsion, cholecystoenteric fistula, Gall bladder lump, or carcinoma. Here the current case is aboutdiscussing a case of a 25-year-old female who presented with symptomatic gallstone disease with aduplicated gallbladder having multiple stones in both the gallbladders. MRCP performedpreoperatively revealed Y type duplication (double Gall bladder with common cystic duct).Laparoscopic cholecystectomy was performed and it finally revealed H type duplication (double Gallbladder with separate cystic ducts for each Gall Bladder).

Diagnosis and Treatment of Laparoscopic Cholecystocolonic Fistula and Cholestoenteric Fistula

Combined with a specific case, CT diagnosis of biliary-intestinal fistula with gallstone intestinal obstruction was analyzed. It was concluded that abdominal plain film was used to diagnose gallstone intestinal obstruction. The key is to observe whether there are positive stones and pneumogallstone in the intestine. The specific imaging features can be obtained by CT diagnosis of cholecystoenteric fistula and surgical treatment of laparoscopic cholecystocolonic fistula.

Xanthogranulomatous cholecystitis complicated by a cholecysto-colonic fistula and liver abscesses†

A 57-year-old male presented to the emergency department with right upper quadrant pain and constitutional symptoms. Initial investigation revealed biliary sepsis with features of chronic cholecystitis, multiple liver abscesses and a fistulous connection between the gallbladder and colon. He was subsequently diagnosed with a cholecysto-colonic fistula, an unusual complication of biliary pathology, with an incidence of 0.06–0.14% at cholecystectomy. It is the second most common form of cholecystoenteric fistula, the first of which is cholecystoduodenal. A preoperative diagnosis was suggested using computed tomography and sinogram imaging. The associated liver abscesses together with the xanthogranulomatous inflammation found on histopathology, makes the case particularly exceptional.

Gallstone ileus: a review

Background Gallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus.Objective This study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature.Conclusions First, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.

Robotic cholecystectomy and cholecystoenteric fistula closure in a female with remote cholangitis

Cholecystocolic fistula (CCF), a connection between the gallbladder and neighboring colon, is a rare entity with little consensus as to the optimal surgical management. Existing case reports have described both open and laparoscopic repairs. We describe the first reported case of a successful robotic repair of a CCF in a 50-year-old woman diagnosed with cholangitis 5 years prior to surgery. The patient had a longitudinal follow-up by a single surgeon, allowing for early diagnosis and repair. This case also includes radiographic imaging over 5 years during the index hospitalization and preoperative workup. This allows for a glimpse into the natural pathogenesis of this disease. After robotic surgery, the patient made a complete recovery with no postoperative complications.

Laparoscopic management of cholecystoduodenal fistula: a case report

Laparoscopic cholecystectomy has been the most widely accepted modality of treatment for patients with gall bladder disease. With time and increasing experience laparoscopic cholecystectomy is now being successfully attempted to treat almost all benign gall bladder pathology and their complications. One such uncommon infrequent complication of cholecystolithiasis is the cholecystoenteric fistula. Management of cholecystoduodenal fistula was traditionally performed by open method. With increasing newer laparoscopic techniques and advancement in the field, cholecystoduodenal fistula, an uncommon clinical entity is now being successfully treated via laparoscopic approach. It is feasible and safer than the conventional open approach in experienced hands, thus decreasing the overall morbidity and mortality attributed to the condition. We report a case of cholecystoduodenal fistula treated successfully by laparoscopic approach using an Endo GIA stapler.

Anatomic Feasibility of Percutaneous Cholecystoenteric Fistula Creation and Stent Insertion in Acute Cholecystitis

Objective. To assess the prevalence of patients whose anatomy would be potentially amenable to percutaneous cholecystoenteric lumen-apposing metallic stents (LAMS) insertion from a population of acute cholecystitis patients. Methods. Contrast-enhanced abdominal computed tomography images in 100 consecutive adult patients with acute cholecystitis were reviewed retrospectively. Feasibility of LAMS placement percutaneously or with endoscopic ultrasound guidance was defined as the presence of a straight and unobstructed trajectory from the skin to the gallbladder, and between the gallbladder and the gastric antrum, or the proximal duodenum, measuring ≤2 cm, respectively. Results. The gallbladder was within 2 cm of the gastric antrum or proximal duodenum without intervening structures in 95 of 100 patients (95%). Percutaneous LAMS appeared anatomically feasible in 90 of 100 patients (90%). Mean ± SD shortest inner-inner wall distance between the gallbladder and the adjacent proximal gastrointestinal tract was 1.20 ± 0.43 cm. The closest location for percutaneous LAMS was between the gallbladder and duodenum in 87 of the feasible cases (97%). The percutaneous approach was transhepatic in 89.5%, and extrahepatic in 10.5%. Endoscopic ultrasound-guided LAMS appeared feasible in 95 of 100 patients, including 5 of the 10 percutaneously unfeasible cases. The other 5 patients appeared unfeasible due to colonic interposition or other intervening structures. Conclusions. LAMS appeared anatomically feasible percutaneously in 90% of acute cholecystitis patients. The shortest and most direct path for percutaneous LAMS was transhepatic and cholecystoduodenal. Percutaneously placed LAMS may be an attractive alternative to percutaneous cholecystostomy.