Cholecystogastric Fistula Research Articles

胆石イレウスにて発症した胆嚢胃瘻の1例

胆嚢消化管瘻は比較的まれな疾患であるが，特に胆嚢胃瘻はまれである．今回われわれはイレウスを契機に発見された胆嚢胃瘻の1例を経験したので，文献的考察を加え報告する．症例は82歳，男性．近医で胃潰瘍の診断を受け抗潰瘍薬を内服していた．嘔吐，心窩部痛を主訴に近医受診し，腸閉塞の疑いで当院紹介となった．腹部CTでは委縮した胆嚢内にairと石灰化を認めた．小腸は拡張し，その先進部には卵殻状石灰化を伴う楕円形の異物を認め，胆嚢消化管瘻，胆石イレウスと診断した．高度の脱水と電解質異常を認めたため，イレウス管を挿入し保存的治療を試みたが改善なく第6病日手術を行った．回腸に5×3cm大の結石が嵌頓しており，回腸切開により結石を摘出した．胆嚢は胃幽門部と肝円索に挟まれるようにして癒着し，胃と瘻孔を形成していた．胆嚢胃瘻と診断し，瘻孔を含めて胆嚢摘出，胃側は縫合閉鎖し大網被覆した．

Íleo biliar: reporte de dos casos

El íleo biliar es una patología poco común y de difícil diagnóstico prequirúgico, pues en la mayoría de los casos se presenta como obstrucción intestinal sin síntomas biliares asociados. En el artículo se presentan dos casos del 2010, cada uno con características diferentes respecto a la localización de la fístula y la evolución postoperatoria: una fístula colecistogástrica con obstrucción del íleon terminal y una fístula colecistoduodenal con obstrucción del yeyuno medio. En el primero se hizo una resolución del íleo biliar y en el mismo tiempo quirúrgico la colecistectomía y cierre de la fístula; mientras que en el otro se trató únicamente el cuadro obstructivo. Dado que en la literatura no existe una amplia revisión de esta situación clínica, no hay consenso en cuanto a la resolución de la patología biliar en el mismo tiempo quirúrgico. Por la evolución clínica de los pacientes tan diversa, se evaluó el problema.

CC-001 An unusual cause of dyspepsia

<h3>Introduction</h3> Dyspepsia is common presentation in gastrointestinal disease. We report a case of new onset dyspepsia referred for open access gastroscopy who was found to have an unusual cause of the pain. <h3>Methods</h3> Case is reported with investigation results and his subsequent management. <h3>Results</h3> A 63-year-old man was referred for open access gastroscopy for new onset dyspepsia. Gastroscopy under throat spray showed a gall stone in the stomach and what appeared to be a fistulous opening adjacent to the pylorus. Further enquiry, immediately after endoscopy revealed a history of upper abdominal pain 5 years ago following which an abdominal ultrasound detected gall stones. Apart from a raised γ-glutamyl transferase (yGT) of 326 IU/l and slightly raised bilirubin of 20 IU/l, all other liver function tests were normal. An abdominal ultrasound showed gas in the biliary tree; the gall bladder could not be visualised properly and the common bile duct measured 8 mm. A computerised tomography (CT) scan subsequently showed a gall bladder which was adherent to the pylorus with a partially calcified calculus in the gall bladder and gas in the cystic duct and intrahepatic ducts. At operation through a right subcostal incision, the pyloric antrum was densely adherent to the gall bladder and there was a cholecystogastric fistula. Small stones were present in the gall bladder but there were no stones in the stomach. The fistula was taken down and the gastric wall was closed with 2/0 polydioxanone suture. A per-operative cholangiogram showed free flow of contrast to duodenum with no stone on the common bile duct. Cholecystectomy was completed; the post operative period remained uneventful and he was discharged home on the fifth post operative day. Histology of the gall bladder revealed chronic cholecystitis with food debris in the gall bladder in keeping with a diagnosis of cholecystogastric fistula. The fistulation between gall bladder and stomach is very rare and &lt;50 cases of cholecystogastric fistula have been reported in the English literature since 1925. The cholecystogastric fistula is more common in women beyond the sixth decade of life. These cases mostly present with mild dyspepsia, but cases presenting with gastric outlet obstruction and upper gastrointestinal haemorrhage have also been described. The diagnosis is made by gastroscopy, ultrasound or CT scan. <h3>Conclusion</h3> Cholecystogastric fistula is a rare cause of dyspepsia. Removal of the gall bladder with closure of the gastric wall has a good outcome if the patient is fit for operation.

Cholecystocolic fistula: a diagnostic enigma.

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 preoperatively. 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 cases. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications.We report here a case of obstructive jaundice, which was investigated with a plain film of the abdomen, abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography, but none of these gave us any clue to the presence of the fistula was discovered incidentally during an open surgery and was appropriately treated.

A Rare Cause of Gastroduodenal Obstruction

Methods: Case Report An 85-year-old female with history of hypertension was admitted to the hospital with a three day history of nausea and vomiting. An abdominal CT was performed and revealed a large calcified mass (Fig. 1) and pneumobilia. A large obstructing duodenal gallstone (Fig. 1) located in the third portion was found on upper endoscopy. Attempts to remove the object endoscopically were unsuccessful. An apparent fistula was found in the duodenal bulb. An enterolithotomy was performed where a 5 cm gallstone was extracted and she did well post-operatively.FigureConclusion: Discussion Bouveret's syndrome is characterized by gastroduodenal obstruction secondary to an impacted duodenal or pyloric channel gallstone via a cholecysto-duodenal or cholecysto-gastric fistula. Clinically patients present with symptoms of obstruction and radiographic studies reveal pneumobilia, cholelithiasis, and a distended stomach. Endoscopic findings include retained food, an impacted stone, and occasionally a fistula which was seen in our patient. Treatment is usually surgery, consisting of an enterolithotomy with or without concomitant cholecystectomy and fistula repair. Recently there have been reports of endoscopic therapy disintegrating gallstones including intracorporal laser lithotripsy, endoscopic mechanical lithotripsy, and electrohydraulic lithotripsy (1). Reference: 1. Gemmel G, Weickert U, Eickhoff A, et al. Successful treatment of gallstone ileus (Bouveret syndrome) by using extracorporal shock wave lithotripsy and plasm coagulation. Gastrointest Endosc 2007;65:173–175.

Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: A new variant of “Bouveret’s syndrome”

Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.

A Case of Xanthogranulomatous Cholecystitis Accompanied by a Cholecystogastric Fistula

A Case of Xanthogranulomatous Cholecystitis Accompanied by a Cholecystogastric Fistula

Cholecystogastric fistula with multiple gallstones causing pyloric obstruction

cholecystogastric fistula with multiple gallstones causing pyloric obstruction

A Case of Endoscopically Collected Cholelith with Cholecystogastric Fistula

A 74-year-old man, who had a history of choledocho-lelithiasis with obstructive jaundice treated by endoscopic papillary balloon-dilation method, admitted to our hospital, because of treatment of diabetes mellitus. Abdominal CT showed cholelithiasis and wall thickening of the gallbladder. We suspected gallbladder cancer, and performed endoscopic retrograde cholangiography (ERC) . When we inserted endoscope, cholelith was found in the antrum of the stomach, and ERC visualized common bile duct (CBD) , atrophic gallbladder and also the stomach. We found fistula on the greater curvature of the antrum, and injected contrast agents under balloon-occlusion, therefore atrophic gallbladder and CBD was seen, and made confirmation as cholecystogastric fistula. Then we collected cholelith endoscopically. Surgical operation was performed with a diagnosis of chronic cholecystitis. Cholecystogastric fistula is very rare among the spontaneous internal biliary fistulae. It is difficult to make a preoperative diagnosis of cholecystogastric fistula, but in our case, we timely performed an examination of ERC, therefore we found cholelith and fistula in the stomach, and were able to confirm as cholecystogastric fistula.

A case of gallstone ileus caused by cholecystogastric fistula with carcinoma of the gallbladder

A case of gallstone ileus caused by cholecystogastric fistula with carcinoma of the gallbladder

胆嚢癌を合併した胆嚢胃瘻の1例

胆嚢癌を合併した胆嚢胃瘻の1切除例を報告する. 症例は74歳の男性. 嘔気, 嘔吐を主訴に他院を受診し, 検査にて内胆汁瘻を疑われ当院に転院となった. 上部消化管内視鏡にて幽門部に嵌頓する結石を認め, また腹部単純CTおよび腹部超音波検査では胆嚢内に結石像を認め, 胆嚢と胃の境界は不明瞭であった. 以上より胆嚢胃瘻による幽門部での胆石の嵌頓と診断し, 開腹手術を施行した. 胆は肝十二指腸間膜および胃幽門部と強固に癒着しており, 幽門小彎前壁に瘻孔を形成し, 胃内には幽門部に嵌頓する径約4cmの結石を認めた. 胆摘, 瘻孔切除および胃壁欠損部の閉鎖を行った. なお術後の病理学的検索にて, 胆嚢頸部から体部にかけての粘液腺癌が認められ, 深達度は漿膜下層であった.胆嚢胃瘻は, 内胆汁瘻に占める割合が約4%とされる比較的まれな疾患であり, さらに胆嚢癌を合併した症例は極めて少なく, 若干の文献的考察を加えて報告する.

Fascioliasis hepática que simularon tumores hepáticos

Two cases of hepatic fascioliasis which simulated hepatic tumors are presented: Patient 1. (42-year-old woman), presented pain in the epigastric and right hypochondrium. US, CAT and MNR suggested a cholangiocarcinoma. She was operated on by practicing hepatic segmentectomy, cholecystectomy and closign of a cholecystogastric fistula. The extirpated hepatic segment presented a tumoral aspect, but its histopathological study revealed numerous granulomas, some of them with F. hepatica eggs and others with Charcot - Leyden crystals. ELISA and complement fixation reaction for fascioliasis resulted positive. Search of F. hepatica eggs in stools was negative. The patient was treated with triclabendazole. Patient 2. (58-year-old woman) also presented pains in the upper hemiabdomen. Hypereosinophilia (32%). Abdominal CAT showed multiple hipondense irregular zones suggesting infiltrative processes in the liver right lobe. The hepatic biopsy, under CAT, eventhough lead to think in a hamartoma, a diagnosis of chronic cholangitis compatible with a parasitic etiology raised. ELISA and complement fixation reaction for fascioliasis were positive. Coproparasitological exams for F. Hapatica resulted negative. She was successfully treated with triclabendazole. Hapatic fascioliasis simulates numerous diseases, among them hepatic tumors.

Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery.

Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 +/- 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 +/- 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n = 11, 55%), cholecystocolic fistulas (n = 5, 25%), cholecystojejunal fistulas (n = 3, 15%), and cholecystogastric fistulas (n = 1, 5%); in the latter group, cholecystoduodenal fistulas (n = 8, 5.1%), and cholecystocolic fistulas (n = 4, 28.6) and cholecystojejunal fistulas (n = 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in either group. One patient in the LT group developed a bronchopneumonia postoperatively. Postoperative hospital stay was significantly longer in LT patients-17 +/- 4 vs 3+/-1 days (p < 0.001). Cholecystoenteric fistula is an occasional intraoperative finding during laparoscopic cholecystectomy. The results of this study, which are based on the collective experiences of 19 surgeons, illustrate the growing success of the laparoscopic approach to this condition, including a decreasing rate of conversion to open surgery over the last 3 years.

Successful preoperative diagnosis of a cholecystogastric fistula using endoscopic retrograde cholangiography: Report of a case

A 64-year-old woman who presented with pyrexia and severe right upper quadrant abdominal pain was suspected of a having a cholecystogastric fistula by the abdominal plain radiograph and gastrointestinal endoscopic findings. The diagnosis was established preoperatively by endoscopic retrograde cholangiography (ERC), following which a cholecystectomy and fistulectomy with resection of the extrahepatic bile duct and hepaticojejunostomy were performed. The patient has remained well since her discharge from hospital.

A CASE OF CHOLECYSTOGASTRIC FISTULA COMPLICATED WITH HEPATOSPLENIC ABSCESS, IN WHICH LITHECBOLE WAS CONFIRMED BY BURROW

Cholecystogastric fistula is relatively rare among idiopathic internal biliary fistulae, and it is said to represent about 4% of all the cases. The disease is rarely complicated with hepatosplenic abscess. This paper describes our experience with a case of the disease with a hepatosplenic abscess, in which we preoperatively confirmed lithecbole by burrow with gastric endoscopy and successfully performed a radical operation. A 51-year-old man was admitted to the hospital because of an abdominal pain and fever. He was confirmed to have hepatosplenicabscess by abdominal ultrasonography and CT and diagnosed as intra-cholecystogastric fistula after close examination. At the time, lithecbole from the fistula at the anterior wall of the antrum was confirmed by gastric endoscopy, and a radical operation was performed. The postoperative couse was uneventful. The hepatosplenic abscess also on an ambulant basis, disappearedand the patient is followed up. Idiopathic internal biliary fistula is a benign disease, but it has been reported that the disease may concursevere cholangitis and accelerate carcinogenesis in leaving it as it is. Early surgical treatment would be principally recommended.

TWO CASES OF CHOLECYSTODUODENAL FISTULA

This paper describes two cases of cholecystoduodenal fistula diagnosed preoperatively. Case 1: A 68-year-old woman was admitted to the hospital because of nausea, fever and general fatigue, which developed during treatments for diabetes and mild hyperternsion. A plain X-ray film of the abdomen, Ultrasonographic examination (US), and computed tomography (CT) showed the presence of free air within the biliary system. Upper gastrointestinal series and gastric endoscopic fistulography revealed cholecysto-duodenal fistula and choledocholithiasis. Case 2: A 52-year-old man was admitted to the hospital because of abdominal pain, fever and jaundice. The patient was found to have a pneumobilia on US and CT. A cholecystogastric fistula was recognized by gastric endoscopic fistulography, but choledocholithiasis was not recognized. At surgery, closing of cholecysto-duodenal fistula, cholecystectomy, incision of the common bile duct and insertion of a T-tube were carried out. These fistulas were comprized of inflammatory changes, which might be an internal biliary fistula due to cholecystitis. These patients are presently going well without any complaints. During a past one decade 216 cases of idiopathic internal biliary fistula have been reported in the Japanese literature. Cholecystitis represents 85-90% of all underlying diseases for this disease, and cholecystoduodenal fistula occurs in a frequency of 50-60%.

A CASE OF GALLSTONE ILEUS CAUSED BY CHOLECYSTOGASTRIC FISTULA

Gallstone ileus is a relatively rare complication of gallstones. It is also rare that cholecystogastric fistula is responsible for this condition. We recently encountered a case of gallstone ileus caused by cholecystogastric fistula. In this case, a radical and one-stage operation on the ileus and the biliary tract was possible under the accurate preoperative diagnosis. A 67-year-old woman was seen at the hospital because of abdominal flatulence and vomiting. When hospitalized, she was in a shock due to ileus. After the improvement of her systemic condition by transfusion therapy and decompression using an ileus tube, a cholecystogastric fistula was detected by endoscopic radiography, and a stone within the intestine, by radiography using an ileus tube. Radical operation was subsequently performed. In the treatment of gallstone ileus, both relief of the ileus and disposal of the internal biliary fistula are required. This condition can be treated radically with one-stage operation after appropriate management and accurate diagnosis.

A CASE OF CHOLECYSTOGASTRIC FISTULA

A 69-year-old woman was found to have a pneumobilia on an abdominal ultrasonographic examination while she was undergoing treatments for diabetes. There was a history of cholelithiasis which was diganosed at the age of 40 and was left untreated. A cholecystogastric fistula was recognized by gastric endoscopic fistulography. Blood chemistry revealed mild abnormalities of liver function. At the operation, the gallbladder was found to be severely atrophic, leaving only the cholecystic duct, with a fistula formation to the antrum. The gastric wall around the fistula was removed together with the gallbladder. Food residues were found in the common bile duct. Marked inflammation of the cholecystic duct was observed.In Japan, 14 cases of cholecystogastric fistula have been reported in the literature. However, no previous case has been reported that food residues are in the biliary duct. Some have the opinion that if there are no symptoms of cholangitis, fistulas to the upper gastrointestinal tracts may be left intact. However, since food residues which get into the biliary tract may cause serious cholangitis, surgical therapy at an early stage is recommended even for asymptomatic patients in principle.

The cholecystogastric fistula

Internal gall bladder fistulas with a hollow viscus following dislocation of a gallstone into the intestine represent one of the late sequelae of cholelithiasis. We report the case of a 78-year-old patient, who suffered from a cholecystogastric fistula with consecutive stone transmigration into the stomach.

Endoscopic diagnosis of asymptomatic cholecystogastric fistula

Endoscopic diagnosis of asymptomatic cholecystogastric fistula