A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.

A rolling stone: vomiting of a gallstone without the presence of a biliary-enteric fistula

ABSTRACT Gallstones may pass into the gastrointestinal tract spontaneously through the ampulla of Vater or through a biliary-enteric fistula. This report describes an extremely rare case of a patient vomiting a gallstone without the presence of a fistula between the gallbladder and the gastrointestinal tract. Furthermore, no imaging findings of gallstones disease appeared. The patient has been treated conservatively and all symptoms subsided. The patient remains asymptomatic 3 months after treatment and an elective laparoscopic cholecystectomy was arranged. Including this reported case, only three cases have been described in the literature worldwide. However, our case is the only one characterized by retrograde flow of the gallstones into the stomach without symptoms of bowel obstruction or other underlying pathologies.

Gastric Outlet Obstruction Due to Cholecysto-Gastric Fistula: Bouveret’s Syndrome

Bouveret’s syndrome is defined as gastrointestinal obstruction due to an impacted gallstone secondary to biliary-enteric fistula. This is often observed with nonspecific symptoms such as epigastric pain, nausea, and vomiting. The diagnosis is made by visualization of pneumobilia, gastric outlet obstruction and ectopic gallstone. In this report, we discussed an elderly patient who was admitted to the emergency department with abdominal pain and vomiting without any signs of bowel obstruction in plain x-ray and ultrasound imaging. We aimed to remind the importance of clinical suspicion and the diagnostic value of computed abdominal tomography for emergency physicians.

An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

Cholecystoduodenal fistula (CDF) is a rare complication of gallbladder disease. Clinical presentation is variable, and preoperative diagnosis is challenging due to the non-specific symptoms of CDF. We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively. This case presentation emphasizes the need to maintain a broad differential diagnosis for abdominal pain out of proportion to exam, with the possibility of a biliary-enteric fistula as a possible cause. It also stresses the importance of a multimodality imaging approach to arrive at a final diagnosis.

Massive upper gastrointestinal bleeding: a rare complication of cholecystoduodenal fistula

A biliary fistula which may occur spontaneously or after surgery, is an abnormal communication from the biliary system to an organ, cavity or free surface. Spontaneous biliary-enteric fistula is a rare complication of gallbladder pathology, with over 90% of them secondary to cholelithiasis. Approximately 6% are due to perforating peptic ulcers. Symptoms of biliary-enteric fistula varies widely and usually non-specific, mimicking any chronic biliary disease. Cholecystoduodenal fistula causing severe upper gastrointestinal (UGI) bleed is very rare. Bleeding cholecystoduodenal fistula commonly requires surgical resection of the fistula and repair of the duodenal perforation. We describe the case of a previously healthy older patient who initially presented with symptoms suggestive of UGI bleeding. Bleeding could not be controlled endoscopically. When a laparotomy was performed, a cholecystoduodenal fistula was discovered and bleeding was noted to originate from the superficial branch of cystic artery.

Laparoscopic Management of Bouveret’s Syndrome after Failed Endoscopic Approach

Bouveret’s syndrome is a complication of cholelithiasis that presents with gastric outlet obstruction due to an impacted gallstone in the duodenum following cholecystoduodenal fistula. This is a rare presentation of biliary-enteric fistula; therefore, there are no standardized guidelines for the management of this disease. We present a case of a patient with Bouveret’s syndrome managed with laparoscopic surgery after an unsuccessful attempt of endoscopic removal.

CASE REPORT OF CHOLECYSTO-DUODENAL FSTULA BY GALLSTONE CAUSING SMALL BOWEL OBSTRUCTON AT KHANH HOA GENERAL HOSPITAL

A rare but serious complication of cholecystolithiasis is the transition of a gallstone in the gastrointestinal tract through a biliary-enteric fistula, thereby causing a traffic mechanical obstruction of intestine. We report a case of cholecysto-duodenal fistula that causes small bowel obstruction by gallstone (gallstone ileus). A 35-year-old male patient with a history of type 1 diabetes and stroke sequelae, clinical presentation of intestinal obstruction with abdominal pain, vomiting, does not fart and defecate, abdominal distention. Multi-slice computer tomography scan of the abdomen shows large dilated small bowel loops containing airfluid levels, colon is in normal aspect, detects foreign body that is spherical and high density like target shape in the distal ileum loop at the right iliac fossa. Result of surgery is a big bile stone with 30mm in diameter located in the ileum loop.