Cholecystoduodenal fistula: ultrasonographic diagnosis with oral gastrointestinal ultrasound contrast medium

Abstract

To determine the value of ultrasonography in the diagnosis of cholecystoduodenal fistulas (CDFs). Twenty-three patients with calculous cholecystitis were suspected to have CDFs on pre-operative ultrasonography. Oral gastrointestinal (GI) ultrasound contrast medium was infused to dynamically observe the presence or absence of a CDF, and the results were compared with the operative findings. The criterion for ultrasonic diagnosis of CDF was dynamic observation of the contrast medium entering the gallbladder through the fistula orifice. Of the 23 enrolled patients, oral GI contrast medium in the duodenum was observed entering the gallbladder through the fistula orifice in 18 patients (78.3%), all of whom were later confirmed operatively to have a CDF. In the remaining 5 patients in whom no GI ultrasound contrast medium was observed entering the gallbladder, 2 were confirmed by surgery to have a CDF, and 3 were shown not to have a CDF. On the basis of routine ultrasonography, dynamic observation through oral infusion of GI ultrasound contrast medium is a simple, practical, non-invasive, and effective method of diagnosing CDF.