Conservative management of the colonic gallstone

A 74-year-old woman presents with a 7-day history of increasing lower abdominal pains and reduced bowel movements; resulting in absolute constipation.Twenty-four hours prior to admission she also had symptoms of nauseous and significant abdominal distention. Her past medical history included; diverticulitis, type 2 diabetes, hypercholesterolemia, an ultrasound scan in 2005 confirming gallstones, but no previous abdominal surgery.She was initially treated for bowel obstruction and a CT arranged. CT showed a 4.5 cm gallstone in mid-sigmoid colon and a cholecystocolonic fistula. She was booked for colonoscopy±laparotomy, but on the morning of her planned procedure she repeatedly opened her bowels. Subsequent colonoscopy was negative and repeat CT confirmed the stone was no longer within the gastrointestinal tract.

1354 A Rare Case of Gallstone Ileus Due to Cholecystocolonic Fistula

Introduction Gallstone Ileus (GI) is an uncommon but potentially lethal complication of cholelithiasis. 50 to 70% of gallstones obstruct in the ileum, the narrowest point of the intestine. More uncommonly the gallstone can travel into the large bowel via an incompetent ileo-caecal valve and impact in the colon at a recto sigmoid junction. GI involving the sigmoid colon is extremely rare cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction. Case Report We describe the case of a 72-year-old man who presented with features of bowel obstruction. CT of abdomen pelvis (CTAP) showed a large 5x5cm intraluminal gallstone obstructing at the rectosigmoid area. It showed presence of pneumobilia and incidental finding of abdominal aortic aneurysm (AAA). An emergency laparotomy revealed a cholecystocolonic fistula. The stone was extracted after milking the stone proximally and loop colostomy formed at colotomy site. The patient made an uneventful recovery. Reversal of stoma was postponed pending endovascular repair of enlarging AAA. Discussion Presenting symptoms of GI are often non-specific, frequently leading to a delay in diagnosis and treatment. Although no fistula was identified in this patient by imaging, the most common cause of GI in most patients is formation of a cholecystoduodenal fistula. Conclusions Compared with biliary enteric fistulae, the occurrence of cholecystocolonic fistulae is remarkably rare. Temporary colostomies can be considered for treating these cases alongside one-stage operations

Cholecystocolonic fistula, a rare cause of lower gastrointestinal bleeding

Resumen La fístula colecistocolónica es una complicación infrecuente de la patología vesicular y supone el segundo tipo más frecuente de fístula colecistoentérica, tras la fístula colecistoduodenal. Tiene una presentación clínica variable, aunque en la mayoría de los casos cursa de forma asintomática y se diagnostica de forma incidental tras colecistectomía. El tratamiento definitivo de esta patología es la cirugía, aunque en algunas ocasiones, teniendo en cuenta la comorbilidad del paciente, puede optarse por un tratamiento conservador con vigilancia estrecha. Presentamos el caso de un paciente con hemorragia digestiva baja masiva como presentación clínica de una fístula colecistocolónica, que dado el rápido deterioro clínico, precisó de manejo multidisciplinar y tratamiento endovascular.