Cholecystocolonic Fistulas from Diverticulosis: A Potentially Missable Cause of Liver Abscesses

Ben Warner,Terry Wong,Philip Berry

doi:10.1155/2016/4803461

Abstract

Cholecystocolonic fistulas (CCF) due to colonic diverticulosis are a rare cause of liver abscesses. It is even rarer to simultaneously have choledocholithiasis, another cause for liver abscesses. In this case report, we found both pathologies and emphasise the need to study cholangiograms carefully so as not to miss alternative diagnoses.

Highlights

Case PresentationAn 82-year-old man with a history of chronic diarrhoea was admitted with severe Gram-negative sepsis, mild jaundice (bilirubin 60 μmol/L), and coagulopathy (INR 1.9)
Cholecystocolonic fistulas (CCF) due to colonic diverticulosis are a rare cause of liver abscesses
An 82-year-old man with a history of chronic diarrhoea was admitted with severe Gram-negative sepsis, mild jaundice, and coagulopathy (INR 1.9)

Summary

Case Presentation

An 82-year-old man with a history of chronic diarrhoea was admitted with severe Gram-negative sepsis, mild jaundice (bilirubin 60 μmol/L), and coagulopathy (INR 1.9). Computed tomography (CT) revealed an 8.8 cm by 8.2 cm liver abscess containing small amounts of gas, inflammatory stranding in both the regions of the gall bladder and hepatic flexure, and aerobilia (Figure 1). Magnetic resonance cholangiopancreatography (MRCP) showed a common bile duct stone. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an 8 mm common bile duct stone with preferential filling of contrast of the left intrahepatic ducts and aerobilia (prior to sphincterotomy) on the right (Figure 2). The collapsed gall bladder filled with contrast (Figure 3), but in later images contrast collected in another viscus, interpreted to be colon (Figure 4). Following identification of the CCF, the patient underwent a colonoscopy. This showed bile staining of the transverse and ascending segments. The patient’s recovery was complicated by a hospital acquired pneumonia from which he died 6 weeks later

Discussion

Findings

Conclusion