A Case of Gallbladder Empyema Causing Cholecystoduodenal Fistula in a Diabetic Elderly Man

Abstract

Introduction: Cholecystoduodenal fistula is a rare complication of cholelithiasis, occurring in less than 5% of cases. We present a case of gallbladder empyema and cholecystoduodenal fistula in an elderly man with diabetes. Case Illustration: A 70-year-old diabetic man was referred to the digestive surgery department on his second week of admission by the internist. He had come in with septic shock that was thought to be caused by pneumonia. He was admitted to the internal ward and treated with antibiotics. He was not showing any significant improvement when he started complaining right upper abdominal pain. He had had a history of right upper abdominal pain that comes and goes, and at one point had been diagnosed with gallstones. However, he had not had any surgeries for the gallstone disease. An abdominal CT-scan was obtained showing multiple gallbladder stone and gallbladder empyema that involved the duodenum causing a cholecystoduodenal fistula. We performed an open cholecystectomy and pyloric exclusion gastro-jejunostomy. The patient recovered well without any complication and was discharged by POD-7. Conclusion: Gallbladder empyema and cholecystoduodenal fistula is often hard to diagnose clinically since the signs and symptoms mimic those of a chronic cholecystitis. However, it should always be contemplated in elderly patients with comorbidities such as diabetes and heart disease.