Cholecystocolonic fistula presenting with intestinal obstruction

Abstract

A cholecystoenteric fistula is defined as the connection between the gallbladder and the gastrointestinal tract. It's a rare complication of acute or chronic cholecystitis. In most cases, fistula occurs with the duodenum, rarely with the stomach or colon [ [1] Hajjar R. Létourneau A. Henri M. Heyen F. Latulippe J. Poirier M. et al. Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting. J Surg Case Rep. 2018; 2018: jy278 Crossref Google Scholar ]. We report the case of an 83-year-old woman presenting to the emergency department complaining of abdominal pain. The patient’s previous medical history was significant for severe coronary artery disease, and acute cholecystitis treated conservatively due to cardiac comorbidity 5-years ago. The patient underwent an abdominal X-ray showing a distended bowel and a radiopaque body in the pelvis (Fig. 1). Subsequent abdominal CT scan revealed the presence of a cholecystocolonic fistula and intestinal obstruction due to a huge gallstone in the sigmoid colon (Fig. 2). The patient underwent colonoscopy with an unsuccessful attempt to remove the stone due to its size (>5 cm). A subumbilical median laparotomy was then performed and local inspection revealed no signs of ischemia. A longitudinal colotomy on the sigmoid colon was conducted with the extraction of the gallstone; colotomy incision was closed and no colostomy was performed. The postoperative course was complicated by wound infection treated with oral antibiotics and the patient was discharged 16 days after surgery. Cholecystocolonic fistula represents an extremely rare cause of intestinal obstruction. CT scan allows recognizing both the cholecystoenteric fistula and the cause of obstruction. Fig. 2Coronal and sagittal CT scan: black arrows indicate gallstone, white arrows indicate cholecystocolonic fistula. View Large Image Figure Viewer Download Hi-res image