Cholecysto-colonic fistula; a rare case.

Abstract

A 72 year old female was referred by her general practitioner (GP) on the urgent two-week waiting list with a history of weight loss, diarrhoea and a mass on the right upper quadrant with a possible underlying malignancy. She had a recent history of jaundice of one month's duration. She was otherwise fit and well. On examination, she was afebrile, icteric, abdomen was soft, non-tender with fullness and possible mass in the right upper quadrant. Routine blood tests yielded elevated bilirubin of 45umol per litre (normal range is up to 17umol per litre of blood), the rest of her blood results were normal. Her GP had requested a Barium enema to look for bowel cancer. This showed a nice image of her biliary tree with communication between gall bladder and colon (fig 1). To evaluate the situation further, we requested an urgent Computerised Tomography (CT) scan which showed a complex mass in the right upper quadrant with no signs of malignancy. Endoscopic retrograde cholangiopancreatography (ERCP) showed a nice image of her transverse colon confirming the fistula. In the same sitting a liberal sphincterotomy to the ampulla was performed. Following the procedure the patient was symptom free. The mass in the right upper quadrant completely resolved confirming the benign nature of the mass. Bilirubin level gradually came down to normal l. Figure 1 The biliary tree is shown with communication between gall bladder and colon. Patient was followed up regularly in the out-patient department for one year. She was completely symptom free and did not require any further intervention therefore she was discharged from our care.