A CASE OF CHOLECYSTOCOLONIC FISTULA PRESENTING WITH MASSIVE GASTROINTESTINAL BLEEDING

Abstract

This paper describes that a 56-year-old male patient presenting with massive gastrointestinal bleeding and megalgia at the upper abdomen was finally diagnosed as cholecystocolonic fistula and successfully surgically treated. The patient, who had been diagnosed as cholelithiasis 3 years ago, experienced gastrointestinal bleeding and shock 4 times, in which the bleeding was first considered to be arisen from somewhere of the colon because endoscopy of the colon revealed a Borrmann type 3-like lesion. During an observation of his course, however, pneumobilia appeared and inner biliary fistula was suspected. ERCP gave a feature of the colon through the gallbbladder that lead to the diagnosis of cholecystocolic fistula which was confirmed by operation. It is relatively rare for massive gastrointestinal bleeding to have the cause in the billiary tract, but is common in the upper GI tract which occur as hematemesis in the most cases. Moreover, the bleeding caused by cholecystocolonic fistula is so extremely rare that only 3 cases have been reoprted in Japan. When a patient suffers from melena or hematemesis, a serial examination of the GI tract should be first performed, then a possible billiary bleeding should be remembered if no remarkable change could be found on the series.