Cholecystocolic Fistula Research Articles

Cholecysto-Colic Fistula: Case Report

Chronic diarrhea as a result of colonic fistulas -two case reports with different origin. When it comes to chronic diarrhea symptom, the first thing one thinks of is never a surgical cause, but an infectious disease. The aim of this paper is to show 2 different cases of chronic diarrhea, resulting from benign surgical causes - colonic fistula. The first case is a result of cholecystocolic fistula, while the second is the result of gastrojejunocolic fistula. Colonic fistulas originate from different causes: malignancy, NSAID, diverticulosis of the colon, cholecystitis, pancreatitis, lymphoma, or after radiation therapy. They can also result from a trauma, which can be post-surgical.

Cholecystoenteric Fistulae—Our Experience

The development of a cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis and it is usually seen to develop in patients with long-standing disease. An incidence of 3–5% has been reported in patients with cholelithiasis and 0.15–4.8% of patients undergoing biliary surgeries may have a CEF (Chowbey et al. J Laparoendosc Adv Surg Tech 16:467–472, 2006). The most common cholecystoenteric fistulae are of the cholecystoduodenal variety (70%), followed by cholecystocolic (8 to 26.5%) and cholecystogastric fistulae (Safaie-Shirazi et al. Surg Gynecol Obstet 137:769–772, 1973; Balent et al. Hawaii J Med Public Health 71:155–157, 2012). In this report, we share our experience of cholecystoenteric fistulae to highlight the presentation, intraoperative findings, and management. Retrospective review of patients with CEF encountered in our experience between 2003 and 2016. Patients admitted for laparoscopic cholecystectomy during this period were involved in the series and patients having cholecystoenteric fistulae were analyzed in detail and their picture is discussed. Among 2450 cholecystectomies encountered, a total of 35 patients had cholecystoenteric fistulae. There were 15 males and 20 females in the age range of 33–76 and with a mean of 55 years. Twenty-eight of the 32 (80%) patients were over 50 years of age. The most common type of fistula was cholecystoduodenal fistula (CDF) and was detected in 32 (91.4%) patients. Other types encountered were cholecystocolic fistula in two patients (5.71%) and cholecystogastric fistula in one (2.857%) patient. Ultrasound was the basic investigation. All cases were diagnosed intraoperatively. Overall 23 patients (65.71%) required a laparotomy. The remaining 12 (34.28%) cases were managed completely by the laparoscopic approach. Earlier in the cases, feeding jejunostomy was regularly used which became occasional in the later part of series. Cholecystoenteric fistulae are rare complication of long-standing gall stone disease. In the era of laparoscopy, many of these cases can be dealt laparoscopically. Low tolerance should be kept for conversion so that patient gets the best possibility of dealing with the condition in the same sitting without added complications.

Endoscopic Closure of Cholecystocolic Fistula: Case Report and Review of the Literature

Endoscopic Closure of Cholecystocolic Fistula: Case Report and Review of the Literature

Acute cholecystitis with Cholecystocolic fistula: a case report and pertinent literature review

Cholecystocolic fistula (CCF) is a rare late complication of gallstones. The clinical features of CCF are nonspecific and variable. No single test is sufficient to diagnose CCF because of the low sensitivity of the tests or the invasive nature of the procedures, and these tests are not routinely requested for asymptomatic patients. Because CCF is rarely diagnosed preoperatively, patient history, laboratory, and radiological data play an important role in alerting surgeons to the possible existence of a CCF. Treatment involves closing the fistula and performing an open or laparoscopic cholecystectomy.

Damage Control Surgery and the Management of a Cholecystocolic Fistula

Damage Control Surgery and the Management of a Cholecystocolic Fistula

Cholecystocolic fistula from colonic diverticular disease with concomitant choledocholithiasis: A case report

We present a 79 year-old female who consulted for abdominal pain. There was evidence of sigmoid diverticulitis with colonic obstruction and biliary-enteric fistula formation, on the imaging. The patient underwent a Hartmann’s Procedure, resection of cholecystocolic fistula, and intraoperative choledochoscopy with common bile duct stone extraction. The pathophysiology and management of cholecystocolic fistula are discussed.

A case of cholecystocolic fistula caused by obstructive cholecystitis due to advanced cancer of the gallbladder

A case of cholecystocolic fistula caused by obstructive cholecystitis due to advanced cancer of the gallbladder

Diagnosis and treatment of cholecystoenteric fistula

Objective To summarize the clinical characteristics and effective preoperative diagnosis of cholecystoenteric fistula (CEF), and investigate clinical effect of laparoscopic surgery. Methods The retrospective descriptive study was adopted. The clinical data of 29 patients with CEF who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2014 were collected. All the 29 patients received upper abdominal ultrasonography, and other accessory examinations were selected according to the condition of individual patient. All the patients received laparoscopic surgery initially. If locally dense adhesions around the gallbladder, difficulty of laparoscopic suture or massive bleeding were encountered intraoperatively, patients were then converted to open surgery. The clinical features, results of accessory examina-tions and preoperative diagnosis, intraoperative status (operation method, operation time, volume of blood loss), postoperative status (time to anal exsufflation, drainage-tube removal time, duration of hospital stay, complica-tions) and follow-up status were recorded. The follow-up including long-term complication was performed by telephone interview and outpatient examination till September 2015. Measurement data with normal distribution were presented as average (range). Measurement data with skewed distribution were presented as M (range). Results (1) Clinical features: all the 29 patients had pain in right hypochondriac region or epigastric region. (2) Preoperative accessory examinations and diagnostic results: preoperative ultrasound examination of all the 29 patients demostrated gallbladder wall thickening in 17 patients, atrophic cholecystitis in 12 patients, gallbladder wall thickening combined with atrophic cholecystitis in 5 patients and pneumobilia in 2 patients. Of 15 patients receiving preoperative abdominal computed tomography (CT) examination, 15 had unclear boundary between gall bladder and gastrointestinal tract and 5 had pneumobilia. Of 7 patients receiving ERCP examination, 4 patients had sinus tract opening and bile spillage and (or) showed sinus tract after injection of contrast agent into common bile duct. Of 5 patients receiving gastroscopy, 1 patient showed sinus tract opening and calculus. Of 3 patients receiving colonoscopy, 1 patient showed sinus tract opening and bile spillage, 2 patients had inflammatory reaction at hepatic flexure of the colon. Nine patients were definitely diagnosed before operation with a preoperative diagnostic rate of 31.0%(9/29), including 6 cases of cholecystoduodenal fistula, 2 cases of cholecystocolic fistula and 1 case of cholecysto-gastric fistula. (3) Intraoperative status: of 29 patients with CEF, 24 patients underwent successfully laparoscopic surgery with average operation time of 85 minutes (range, 50-130 minutes) and intraoperative volume of blood loss of 45 mL (range, 30-110 mL). Five patients were converted to open surgery, with average operation time of 150 minutes (range, 120-200 minutes) and intraoperative volume of blood loss of 120 mL(range, 60-250 mL). (4) Postoperative status: the average time to anal exsufflation, drainage-tube removal time and duration of hospital stay were 2 days (range, 1-3 days), 3 days (range, 2-4 days) and 4 days (range, 3-6 days) in 24 patients undergoing laparoscopic surgery. Two patients had postoperative compli-cations and recovered after symptomatic treatment. One of 5 patients converted to open surgery died of multiorgan failure. The average time to anal exsufflation, drainage-tube removal time, duration of hospital stay were of the rest 4 patients were 5 days (range, 3-6 days), 6 days (range, 3-7 days), 14 days (range, 11-19 days). Two patients had postoperative complications and recovered after symptomatic treatment. (5) Follow-up status: 25 patients were followed up for a median time of 25 months (range, 13-38 months) with a follow-up rate of 89.3%(25/28). There were no long-term complications during the follow-up. Conclusions Pain in right hypochondriac region and (or) epigastric region is common symptom of CEF. Ultrasonography and CT provide valuable diagnostic clues to CEF. Laparoscopic surgery is safe, effective and feasible to treat CEF for experienced laparoscopic surgeons. Key words: Cholecystoenteric fistula; Clinical features; Diagnosis; Laparoscopy

Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome.

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann's pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely.

Laparoscopic management of cholecystocolic fistula: case report and review literature

Cholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition. With an increasingly reproducible tendency to the use of laparoscopy, laparoscopy for resolution of cholecystocolic fistula is not only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy. Here we present a case report of cholecystocolic fistula repaired with laparoscopy.

A case of cholecystocolic fistula incidently found with a positive fecal occult blood test and finally diagnosed with endoscopic retrograde cholangiopancreatography

A case of cholecystocolic fistula incidently found with a positive fecal occult blood test and finally diagnosed with endoscopic retrograde cholangiopancreatography

単孔式腹腔鏡下手術を施行した無症候性胆囊結腸瘻の１例

単孔式腹腔鏡下手術によって根治しえた無症候性胆囊結腸瘻の１例を経験した．症例は74歳，女性．自覚症状は認めなかったが，腹部超音波検査で胆囊結石を指摘され当院を紹介受診された．腹部CTおよびMRCPにおいて胆囊底部と横行結腸との境界が不明瞭であり胆囊結腸瘻が疑われた．胆囊内部には多数の結石も認められた．以上より胆囊結石症，胆囊結腸瘻と診断し手術の方針となった．２mmの細径鉗子を併用した単孔式腹腔鏡下手術を施行し，胆囊摘出および横行結腸部分切除を行った．合併症なく経過され，術後８日目に軽快退院された．内胆汁瘻の中では胆囊結腸瘻の頻度は少ないものの，可動性のある横行結腸と瘻孔を形成している例が多いため腹腔鏡下手術が行いやすい疾患であると考えられ，臍部小切開による単孔式腹腔鏡下手術でも根治が可能であった．胆囊結腸瘻に対する単孔式腹腔鏡下手術はより低侵襲な治療法であり，術式の選択肢の一つとなりうると考えられた．

Unusual cause of diarrhoea – cholecystocolic fistula: case interpretation and overview of literature

Unusual cause of diarrhoea – cholecystocolic fistula: case interpretation and overview of literature

Bilioenteric Fistula - Not any more a contraindication for Laparoscopic Cholecystectomy

Background: Bilioenteric fistulas include cholecystoduodenal fistula, cholecystocolic fistula, and cholecystogastric fistula. They are known but rare complication of cholecystitis. Previously presence of any cholecystoenteric fistula was an indication to convert laparoscopic cholecystectomy to open operation1. But with time and experience new techniques, new technology and expertise has developed in the laparoscopic field and now the scenario is changed. This is our experience in a tertiary care diabetic hospital where we encountered 21 cases of cholecystoenteric fistula during laparoscopic cholecystectomy over a period of 2 years. Our series: From January 2013 to January 2015 we performed 1191 cases of laparoscopic cholecystectomy in our unit. We encountered 12 cases of cholecystoduodenal fistula, 7 cases of cholecystocolic fistula and 2 cases of cholecystogastric fistula. All cases were diagnosed during laparoscopy, and were dealt with laparoscopy. Intracorporeal suturing was used in all cases.Observation: Successful per operative diagnosis requires suspicion and careful adhesiolysis in all cases. Avoiding conversion to open operation reduces hospital stay, pain, wound infection and chest complications associated with upper abdominal incision. As the fistulous tract is usually near the fundus and far away from Callots there is not much increased risk of common bile duct injury.Conclusion: Cholecystoenteric fistulas can now safely be managed laparoscopically in advanced centers by experienced surgeon.Bangladesh Crit Care J March 2015; 3 (1): 7-8

Cholecystocolic fistula caused by gallbladder carcinoma: Preoperatively misdiagnosed as hepatic colon carcinoma

Cholecystocolic fistula secondary to gallbladder carcinoma is extremely rare and has been reported in very few studies. Most cholecystocolic fistulae are late complications of gallstone disease, but can also develop following carcinoma of the gallbladder when the necrotic tumor penetrates into the adjacent colon. Although no currently available imaging technique has shown great accuracy in recognizing cholecystocolic fistula, abdominopelvic computed tomography may show fistulous communication and anatomical details. Herein we report an unusual case of cholecystocolic fistula caused by gallbladder carcinoma, which was preoperatively misdiagnosed as hepatic flexure colon carcinoma.

Laparoscopic management of cholecystocolic fistula.

IntroductionCholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy.AimTo describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments.TechniqueAfter dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery.ConclusionLaparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy.

Cholecystocolic Fistula: A Diagnostic Dilemma

Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools a high degree of suspicion is required to diagnose it preoperatively1,2. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10-20%), and the least common is the cholecystogastric fistula accounting for the remainder of the cases. Even a case of choledochocolonic fistula through a cystic duct remnant has been reported3. These fistulae are treated by open as well as laparoscopic surgery with no difference in intraoperative and postoperative complications. We report a case of obstructive jaundice, which was relieved by itself and was investigated with abdominal ultrasonography and routine investigations but none of these gave us any clue to the presence of the fistula which was discovered incidentally during an open surgery and was appropriately treated. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19156 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.329-331

腹腔鏡下手術にて切除した胆嚢結腸瘻の1例

症例は86歳，男性．心窩部痛を訴え来院した．腹部CT検査では胆嚢内，肝内胆道内にガス像を認めた．内視鏡的逆行性胆管造影では胆嚢は描出不良であり瘻孔所見は認めなかったが，便臭伴う胆汁が吸引され，胆嚢結腸瘻が強く疑われた．総胆管ステント留置行い，精査の後に待機的な腹腔鏡下手術を施行した．横行結腸との瘻孔形成を認めた．癒着剥離行い，胆嚢管を処理した．肝床部から剥離し，瘻孔部は切離せず胆嚢および横行結腸を一塊として授動した後，小開腹を加え横行結腸部分切除術を行った．術後は合併症なく経過し，術後13日目に転院した．胆嚢結腸瘻に対しても腹腔鏡下手術にてより低侵襲に治療することが可能であると考えられた．

Transmural invasion of hepatic flexure of colon causing cholecystocolic fistula by aggressive gallbladder carcinoma

Spontaneous enterobiliary fistulae are a complication of biliary disease or a disease of adjacent structures. Cholecystocolic fistulae are rare in relation to gallbladder carcinoma (GBC). Previous reports have presented images showing subtle findings suggestive of cholecystocolic fistula. We report the unusual spread and rare images of a case of cholecystocolicfistula,to highlight the aggressive nature of GBC and findings of gross transmural invasion of the colonic wall. The images acquired in all three planes define the anatomical and pathological extent conclusively. There are a higher number of GBC cases across the geographic belt of North India compared to the West. In this case, the patient’s pathology was extensive and unresectable, and therefore palliative and supportive care wasadvised.

Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an elderly woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months later.