Abstract
The bilioenteric fistulas, first described in 1890 by Courvoisier, are found in 0.15% - 8% of biliary tract operations. Combined fistulas involving the gallbladder, duodenum and colon are extremely rare. We presented a case of 38 year female who presented to our OPD with complaints of pain right upper abdomen for seven months in whom a cholecysto-duodenocolic fistula (Figure 1 & Figure 2) was found during surgery which was repaired primarily. Gallstone disease is a common problem in hepatobiliary system and may rarely present as cholecysto-enteric fistula. The most common type of biliary enteric fistula is Cholecystoduodenal fistula (70%). Cholecysto-duodeno-colic (CDC) fistula is a rare complication of cholelithiasis. The standard treatment of IBF is cholecystectomy and repair of the fistulous opening. Although very rare a cholecystoduodenocolic fistula should be kept as a possibility when there are adhesions between GB, duodenum and colon. Conversion to open surgery should be considered early when the anatomy is not clear to prevent iatrogenic injury.
Highlights
A biliary fistula is an abnormal passage or communication from the biliary system to an organ, cavity, or free surfaces
Internal biliary fistula (IBF) is associated with chronic cholelithiasis in 90% of the cases
Gallstone disease is a common problem in Indian subcontinent. It can present as acute cholecystitis, gall stone pancreatitis, obstructive jaundice, gallstone ileus or cholecysto-enteric fistula
Summary
A biliary fistula is an abnormal passage or communication from the biliary system to an organ, cavity, or free surfaces. Internal biliary fistula (IBF) is associated with chronic cholelithiasis in 90% of the cases. Cholecystocolonic fistula (CCF) is a late complication of long-lasting gallstone disease and is found in roughly 1 in every 1,000 cholecystectomies. It is the second most common cholecystoenteric fistula after the Cholecystoduodenal [11]-[13]. Symptoms of CCF are usually minimal and/or non-specific, and preoperative diagnostic tools often fail to show such a rare condition, diagnosis is often achieved intraoperatively [14] [15]. A double communication of the gallbladder with both the duodenum and colon is rare in this condition, only five previous cases having been recorded in the English literature (Doromal, Estacio and Sherman, 1975; Dowse, 1963; Pitman and Davies, 1963; Shocket, Evans and Jones, 1970) [17]
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