Choledochocolonic fistula secondary to primary choledocholithiasis

Abstract

An 87-year-old man was hospitalized because of jaundice. His medical history included diabetes and hypertension. There was no history of abdominal surgery. The patient also complained of colicky upper abdominal pain of about 6 months duration. At ERCP, the major duodenal papilla looked normal. Retrograde cholangiography showed a triangular filling defect in the mid extrahepatic bile duct and a fistula tract between the bile duct and the colon. A biliary sphincterotomy was performed but it was not possible to pass a Dormia basket around the large stone in order to extract and/or crush it. A nasobiliary drain was placed (A) (A, bile duct; B, colon; arrowhead, choledochocolonic fistula; arrow, filling defect), and the patient was referred for surgery. At operation, agenesis of the gallbladder was noted and the fistulous tract between the bile duct and the hepatic flexure of the colon was confirmed along with a 2 × 3-cm stone in the bile duct (B) (A, bile duct; B, hepatic flexure of colon; arrowhead, choledochocolonic fistula; arrows, stone in bile duct).