A CASE OF SPONTANEOUS CHOLECYSTODUODENAL FISTULA DISCOVERED FOLLOWING EXTIRPATION OF A GALLSTONE LOCKED IN THE ANAL CANAL

Abstract

We report a case of spontaneous cholecystoduodenal fistula. A 76-year-old man complained of epigastralgia and vomiting. After relieving transient ileus, a 20 mm-sized gallstone was extripated out of the anal canal which was stenotic due to previous operation of internal hemorrhoids.Abdominal plain film, ultrasonogram, and CT showed pneumobilia and gallstones. Endoscopic retrograde cholangiogram and upper GI tract series revealed a communication between the gallbladder and duodenum, and we got a diagnosis of spontaneous cholecystoduodenal fistula and residual stones in gallbladder. So radical operation was performed for prevention from recurrent gallstone ileus, secondary biliary infection and liver dysfunction. There was a fistula of 15 mm in diameter between the ampulla of gallbladder and the bulbus of duodenum. Operative cholangiogram revealed no other fistula, and cholecystectomy, closure of the fistula, choledochotomy and T-tube drainage were performed.Spontaneous internal biliary fistulas are abnormal communications between the biliary tract and its adjacent organs, caused not by such external factors as operation and injury. Eighty-five to ninety percent of the cases are caused by cholelithiasis. It principles of treatment are followings: 1) treatment of basic disease, 2) resection and closure of fistula, and 3) appropriate drainage of biliary tract.