1453 Cholecystocolic Fistula: An Unusual Cause of Abdominal Pain

Abstract

INTRODUCTION: Biliary-enteric fistula is a rare but a pertinent complication of gallbladder disease. It is usually a complication of acute cholecystitis. It occurs in 0.06%-0.14% of patients with biliary disease. Cholecystoduodenal (70%) is the most common site of communication of the fistula, followed by cholecystocolic (10-20%), and then cholecystogastric fistula (10-20%). Failure to identify these fistulas during cholecystectomy can have catastrophic complications as it may result in division of the fistula, perforation of the colon that can result in fecal peritonitis which ultimately can lead to sepsis and death. We are reporting a 57-year-old female presenting with diffuse sharp abdominal pain, nausea, vomiting who was found to have a cholecystocolic fistula and a 1.7 cm gallstone in the proximal sigmoid colon. CASE DESCRIPTION/METHODS: A 57-year-old Caucasian Female with a history of diverticulosis presented with diffuse sharp worsening abdominal pain, nausea, vomiting and diarrhea. Her physical exam was normal except for diffuse abdominal tenderness. Her Laboratory findings were unremarkable including her liver function tests. An abdominal CT scan showed a non obstructing 1.7 cm gallstone in the proximal sigmoid colon and a fistula between the hepatic flexure and the gallbladder (Figures 1 and 2). It also showed evidence of colitis in in the distal left colon and proximal sigmoid colon. Patient was scheduled for a cholecystectomy with fistula repair. DISCUSSION: Cholecystocolic fistula is a rare but a pertinent complication of gallbladder disease. Although a diagnosis of cholecystocolic fistula is rarely suspected clinically, Clinicians should be aware of it given that it can have catastrophic complications.