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Singh K, S Kumar N, Lokavarapu MJ, Ammapalem S, Selvarasu M, Gupta A. Cholecystoenteric Fistula: A Single-Center Experience of Seven Cases with Unusual Complications of Gallstone Disease. Cureus 2025; 17:e81350. [PMID: 40291290 PMCID: PMC12034233 DOI: 10.7759/cureus.81350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Cholecystoenteric fistulas (CEFs) are rare complications of chronic calculous cholecystitis, often diagnosed intraoperatively due to their nonspecific clinical presentation and challenges in preoperative detection. This study analyzes the surgical management and outcomes of CEFs at a tertiary care center. METHODS A retrospective analysis was conducted on all patients who underwent surgery for CEF in the hepatopancreaticobiliary unit of the Department of Surgery at the All India Institute of Medical Sciences, Rishikesh, India, between June and December 2024. Data on preoperative characteristics, biochemical parameters, intraoperative findings, surgical techniques, conversion rates, and postoperative outcomes were collected and analyzed. RESULTS Seven patients were included, with a mean age of 55.6 years (range: 49-69 years). Abdominal pain was the most common symptom (seven, 100%), while cholangitis was present in three (42.86%) cases. Gallstones were found in all patients (seven, 100%) and bile duct stones in two (28.57%). Multiple fistulas were observed in four (57.14%) cases, with cholecystocolonic fistulas (CCFs) and cholecystoduodenal fistulas (CDFs) being the most common combinations. Laparoscopic surgery was attempted in four (57.14%) cases but required conversion to open surgery. Bilioenteric anastomosis with Roux-en-Y hepaticojejunostomy was performed in three (42.86%). Postoperative complications included surgical site infections in two (28.57%) of the cases, and one (14.29%) died in the postoperative period. The mean hospital stay was 13.4 ± 3.8 days. CONCLUSION Cholecystoenteric fistula remains a diagnostic and surgical challenge due to its nonspecific presentation and intraoperative detection. While preoperative imaging can aid in diagnosis, most cases are identified intraoperatively, necessitating modifications in the surgical approach. Advances in laparoscopic techniques have reduced conversion rates, but complex cases still require open surgery. Further studies with larger cohorts are needed to refine diagnostic and therapeutic strategies.
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Affiliation(s)
- Karamveer Singh
- Department of General Surgery and Division of Organ Transplant, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Nayana S Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Manoj Joshua Lokavarapu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Satish Ammapalem
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Monisha Selvarasu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Amit Gupta
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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2
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Cheng YJ, Liu CY, Li ZL, Xiao N. Perforated gangrenous cholecystitis, cholecystoduodenal fistula and intestinal obstruction caused by gallbladder stones: A case report. Asian J Surg 2024; 47:4958-4959. [PMID: 38845318 DOI: 10.1016/j.asjsur.2024.05.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/24/2024] [Indexed: 11/09/2024] Open
Affiliation(s)
- Yi-Jun Cheng
- Department of Urology Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Can-Yu Liu
- Department of Plastic Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zong-Lin Li
- Department of Urology Surgery, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Nan Xiao
- Department of Urology Surgery, The Second Hospital of Lanzhou University, Key Laboratory of Urinary Diseases Research of Gansu Province, Gansu Province Clinical Research Center for Urology, Lanzhou, 730030, China.
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3
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Aljohani E, Awadalla M, Abdelkarim W, Alkadrou A. Cholecystogastric fistula: A case report and review of the literature. Int J Surg Case Rep 2024; 122:110141. [PMID: 39151392 PMCID: PMC11375240 DOI: 10.1016/j.ijscr.2024.110141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Cholecystogastric fistula is an abnormal communication between the gallbladder and the stomach, it is a rare complication of chronic cholethiasis. Preoperative diagnosis is difficult as patients often present with non-specific symptoms. CASE PRESENTATION A 63-year-old female presented to the outpatient clinic with symptomatic cholelithiasis. Physical examination was unremarkable. Laboratory investigations, including complete blood count (CBC) and liver function test (LFT), were within normal limits. Upper abdominal ultrasound revealed hepatomegaly and gallbladder contraction with multiple gallstones. Intraoperative exploration during laparoscopic cholecystectomy revealed adhesions with cholecystogastric fistula, necessitating meticulous dissection, fistula excision, and primary closure. Postoperatively, the patient recovered uneventfully, with a negative methylene blue leak test allowing early oral intake. Discharged home in stable condition, subsequent follow-up showed resolution of symptoms, and histopathological examination confirmed absence of neoplastic changes. DISCUSSION Optimal surgical management of cholecystogastric fistula is debatable, laparoscopic surgery have led to improved outcomes in the management of these cases. Utilizing which approach should be determined based on the clinical scenario for each patient and the surgeon experience. CONCLUSION Cholecystogastric fistula is a rare complication of chronic cholethiasis. Preoperative diagnosis requires high index of suspicion. Complete laparoscopic management is safe.
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Affiliation(s)
- Emad Aljohani
- Associate Professor, Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia.
| | - Matar Awadalla
- General Surgery Consultant, Department of Surgery, Dr. Suliman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Wala Abdelkarim
- General Surgery Specialist, Department of Surgery, Dr. Suliman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Abdulkarim Alkadrou
- General Surgery Resident, Department of Surgery, Dr. Suliman Alhabib Medical Group, Riyadh, Saudi Arabia
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4
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Tan JR, Lunevicius R. Cholecystoappendiceal fistula associated with xanthogranulomatous cholecystitis. BMJ Case Rep 2024; 17:e260954. [PMID: 39209744 DOI: 10.1136/bcr-2024-260954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Xanthogranulomatous cholecystitis is a rare chronic inflammatory disease of the gallbladder associated with complications such as perforation, dense adhesions and fistulation. We present a case of a female patient in her 20s who presented with three episodes of recurrent cholecystitis over 3 months. Her medical history included an endoscopic retrograde cholangiopancreatography for obstructive jaundice due to choledocholithiasis. As there was no possibility of performing an urgent cholecystectomy during her initial admission, she was listed for an elective operation. Laparoscopic inspection revealed a pericholecystic mass involving the omentum, transverse colon, duodenum and liver and findings suspicious of a cholecystoappendiceal fistula. Laparoscopic cholecystectomy and appendicectomy were performed. Early index admission laparoscopic cholecystectomy should be performed in patients with acute cholecystitis to prevent higher grades of operative difficulty and associated complications. This case presentation-cholecystoappendiceal fistula associated with xanthogranulomatous cholecystitis-emphasises the necessity of complying with national guidelines in managing acute calculous cholecystitis.
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Affiliation(s)
- Jay Roe Tan
- Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Raimundas Lunevicius
- Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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5
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Bagnoli M, Maranto D, Dunn L, McKinney D, Steen E. Robotic-Assisted Cholecystoduodenal Fistula and Bile Leak Repair. Cureus 2024; 16:e66583. [PMID: 39252748 PMCID: PMC11382923 DOI: 10.7759/cureus.66583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/11/2024] Open
Abstract
Cholelithiasis and its complications are among the most prevalent and costly medical conditions in the United States. Chronic gallbladder disease can progress into more complicated conditions, such as a cholecystoenteric fistula and, more specifically, a cholecystoduodenal fistula (CDF). Repair of these fistulas is complex and usually performed with an open approach. However, if discovered pre-operatively, they can be referred to a hepatobiliary surgery center, where surgeons have specialized training to do such procedures laparoscopically. Here, we present a case of a 57-year-old female with a past medical history of migraines, arthritis, chronic back pain, and fibromyalgia, with no prior surgical history. She presented with an approximately six-month history of colicky right upper quadrant pain and symptomatology consistent with symptomatic cholelithiasis. She elected to have a robotic-assisted laparoscopic cholecystectomy performed. Intraoperatively, she was found to have a CDF and subsequent bile duct leak that were successfully repaired. While more research is required to further characterize and more quickly identify this complication of gallbladder disease, this case highlights the value of robotic-assisted surgery in technically challenging cases. We aim to describe and advocate for the adoption of a robotic approach in patients with comparable presentations, allowing for excellent visualization and control in the removal of inflamed gallbladders, repair of fistulized tissues, and stabilization of bile leaks.
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Affiliation(s)
- Michael Bagnoli
- Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Devon Maranto
- Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Leah Dunn
- Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | | | - Eric Steen
- General Surgery, Lewis Gale Medical Center, Salem, USA
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6
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Muralidhar V, Ajmal IT, Anand P, Rino RV. Choledocho-gastric fistula due to chronic peptic ulcer with gastric outlet obstruction and pneumobilia. BMJ Case Rep 2024; 17:e259395. [PMID: 38383119 PMCID: PMC10882302 DOI: 10.1136/bcr-2023-259395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- Venkiteswaran Muralidhar
- General Surgery, Chettinad Academy of Research and Education, Kanchipuram, India
- Bioinfromatics, University of Birmingham, Birmingham, UK
| | - Imran Tariq Ajmal
- General Surgery, Chettinad Academy of Research and Education, Kanchipuram, India
| | - Priyanka Anand
- General Surgery, Chettinad Academy of Research and Education, Kanchipuram, India
| | - Roshan V Rino
- General Surgery, Chettinad Academy of Research and Education, Kanchipuram, India
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7
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El Feghali E, Akel R, Chamaa B, Kazan D, Chakhtoura G. Surgical management of gallstone ileus after one anastomosis gastric bypass: A case report. World J Gastrointest Surg 2023; 15:2083-2088. [PMID: 37901746 PMCID: PMC10600774 DOI: 10.4240/wjgs.v15.i9.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Gallstone ileus following one anastomosis gastric bypass (OAGB) is an exceptionally rare complication. The presented case report aims to highlight the unique occurrence of this condition and its surgical management. Understanding the clinical presentation, diagnostic challenges and successful surgical intervention in such cases is crucial for healthcare professionals involved in bariatric surgery. CASE SUMMARY We present a case report of gallstone ileus following OAGB and discuss its diagnosis and surgical management. A 66-year-old female with a history of OAGB presented to the emergency room with symptoms of small bowel obstruction. Computed tomography scan revealed a gallstone impacted in the distal ileum, causing obstruction. The patient underwent a laparoscopically assisted enterolithotomy, during which the gallstone was extracted and the enterotomy was closed. The patient had an uneventful recovery and was discharged on postoperative day four. CONCLUSION Gallstone ileus should be considered as a possible complication after OAGB, and prompt surgical intervention is usually required for its management. This case report contributes to the limited existing literature, providing insights into the management of this uncommon complication.
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Affiliation(s)
- Elie El Feghali
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Rhea Akel
- Department of Radiology, Saint Joseph University, Beirut 1107, Lebanon
| | - Bilal Chamaa
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Daniel Kazan
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Ghassan Chakhtoura
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
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8
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Zhu C, Zeitouni F, Vaughan J, Santos AP. Laparoscopic management of combined cholecystogastric and cholecystocolonic fistulae. BMJ Case Rep 2023; 16:e255951. [PMID: 37558278 PMCID: PMC10414080 DOI: 10.1136/bcr-2023-255951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Cholecystogastric and cholecystocolonic fistulae are rare sequelae of longstanding cholelithiasis and can complicate surgical management. Our case involves a male patient in his early 40s with a history of chronic cholelithiasis who presented to the emergency department with severe abdominal pain. Findings on imaging were consistent with acute calculous cholecystitis. During laparoscopic cholecystectomy, the presence of both cholecystogastric and cholecystocolonic fistulae was discovered. Fistula resection with cholecystectomy in a one-step approach using indocyanine green (ICG) angiography was performed. The patient improved and was discharged 3 days later. Laparoscopic management complemented by ICG angiography is a viable surgical approach in patients with cholecystogastric and cholecystocolonic fistulae.
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Affiliation(s)
- Christina Zhu
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Ferris Zeitouni
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Justin Vaughan
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Covenant Medical Center, Lubbock, Texas, USA
| | - Ariel P Santos
- Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Covenant Medical Center, Lubbock, Texas, USA
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9
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Finch LM, Robinson PD, Szentpali K. Utilising Hem-o-lok ® ligation system to safely and efficiently divide bilioenteric fistulae in laparoscopic cholecystectomy. Ann R Coll Surg Engl 2023; 105:579-580. [PMID: 36263916 PMCID: PMC10318749 DOI: 10.1308/rcsann.2022.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 07/03/2024] Open
Affiliation(s)
- LM Finch
- Hampshire Hospitals NHS Foundation Trust, UK
| | - PD Robinson
- Hampshire Hospitals NHS Foundation Trust, UK
| | - K Szentpali
- Hampshire Hospitals NHS Foundation Trust, UK
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10
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Uhe I, Litchinko A, Liot E. Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature. Front Surg 2023; 10:1206828. [PMID: 37409067 PMCID: PMC10318342 DOI: 10.3389/fsurg.2023.1206828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023] Open
Abstract
Peptic ulcer disease (PUD) is a very common condition, with an annual incidence ranging from 0.1% to 0.3% and a lifetime prevalence ranging from 5% to 10%. If not treated, it can lead to severe complications such as gastro-intestinal bleeding, perforation, or entero-biliary fistula. Entero-biliary fistulas and especially choledocho-duodenal fistula (CDF) are a rare, but relevant and important diagnosis, which can lead to several complications such as gastric outlet obstruction, bleeding, perforation, or recurrent cholangitis. In this article, we present the case of an 85-year-old woman with PUD complicated with gastro-intestinal bleeding and a CDF. We also performed a review of the literature to search for pre-existing cases with this atypical clinical presentation. The aim was to raise awareness among surgeons and clinicians by offering a summary of different types of entero-biliary and especially CDF, existing diagnostic investigations, and management.
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11
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Walia DJS, Singla A, Singh S, Dua J. A Rare Case of Cholecystoduodenal and Cholecystocolic Fistula with Gallstone Ileus. Int J Appl Basic Med Res 2023; 13:121-123. [PMID: 37614840 PMCID: PMC10443450 DOI: 10.4103/ijabmr.ijabmr_598_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 08/25/2023] Open
Abstract
Cholecystoduodenal and cholecystocolic fistula (CCF) is a rare condition, occurring in patients with cholelithiasis. Multiple complex fistulas are even rare. This is a case study done to detail such a rare case, very few such cases have been reported in the past studies, with cholecystoduodenal and CCF with gallstone ileus. We present the case of an 80-year-old, female diagnosed with intestinal obstruction. Intraoperatively, the gallbladder (GB) fundus forms a CCF and the body of the GB with the first part of the duodenum forms cholecystoduodenal fistula. Gallstone ileus found impacted in jejunum 35 cm distal to DJ junction. Resection of fistula tracts with primary repair of the transverse colon was done with Graham's patch repair of duodenum and fundus first cholecystectomy. Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are very rare. In the case of gallstone ileus, the surgical treatment is an emergency and the only therapeutic option.
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Affiliation(s)
| | - Anand Singla
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Sandeep Singh
- Department of Medicine, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Jasmeen Dua
- Department of Medicine, GMC and Rajindra Hospital, Patiala, Punjab, India
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12
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Muacevic A, Adler JR, Khan A, Danawar NA. Successful Treatment of Cholecysto-Antral Fistula: A Case Report. Cureus 2023; 15:e33580. [PMID: 36779134 PMCID: PMC9909495 DOI: 10.7759/cureus.33580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Cholecysto-antral fistula and gallstone ileus are rare complications of a common disease, gallbladder stone (GBS). This fistula is developed as a prolonged complication of cholelithiasis in which the gallbladder adheres to the adjacent antrum, and a stone erodes through the wall. Among the variety of cholecystoenteric fistulae, the cholecystoduodenal fistula occurs more commonly than the cholesysto-antral fistula. In this scientific study, we present a 98-year-old male patient who came to ER with a complaint of abdominal pain, vomiting, and constipation for five days. He was vitally stable and had normal laboratory results. The plain abdominal X-ray showed dilated loops with excessive gases. His computed tomography (CT) abdomen with contrast showed small bowel obstruction secondary to an impacted gallstone at the distal jejunum, fistulous communication between the gall bladder and the antrum, and pneumobilia. Our management included endoscopic retrieval of a single gallstone from the second part of the duodenum followed by open surgical enterolithotomy, partial cholecystectomy, and closing of the fistula. Despite our case sharing many aspects with the available literature, our case, to our knowledge, is the first case of ileus gallstone occurring in a 98-year-old patient. Cholecysto-antral fistula has not been widely published in the literature. The offending gallstone presented along with the radiological Mercedes Benz sign which does not present in all cases of GBS. Typically, the obstructing GBS stops at the terminal ileum, but in our case, it was dislodged in the distal jejunum with no previous biliary symptoms. Finally, we were able to remove another single GBS from the second part of the duodenum during the preoperative upper endoscopy. The clinical diagnosis may be missed due to the vague presentation of symptoms; hence imaging, especially of the CT abdomen is crucial in establishing the diagnosis, moreover, performing an upper endoscopy could have diagnostic and therapeutic benefits. In cases like this, the main surgical intervention should be to address the bowel obstruction, and cholecystectomy with fistula closure may be added if the patient's condition is stable with minimal inflammation and adhesion.
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13
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Muacevic A, Adler JR. Cholecystoduodenal Fistula: A Case Series of an Unusual Complication of Gallstone Diseases. Cureus 2022; 14:e31651. [PMID: 36545161 PMCID: PMC9760288 DOI: 10.7759/cureus.31651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
The usual complications of gallstone diseases are acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. Most of the patients who present with these complications have a prior history suggestive of gallstone diseases. Cholecystoenteric fistula is a very uncommon complication of gallstone disease, and many patients do not have a previous history suggestive of biliary pathology. Gallstone ileus is a mechanical cause of intestinal obstruction due to the passage of a large stone through the cholecystoenteric fistula. These patients present with vague clinical signs and symptoms and non-specific laboratory abnormalities; hence, a high index of suspicion is needed for early diagnosis and management of the same. Once diagnosed, controversies exist in their appropriate surgical management. We present a series of four cases of cholecystoduodenal fistula, two patients presenting with gallstone ileus, and two patients presenting with cholangitis and their successful surgical management.
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14
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Fukuda Y, Michiura T, Ito D, Takahashi T, Tokuyama S, Morishita H, Nuta J, Miyazaki Y, Hayashi N, Yamabe K. Indirect cholecystoduodenal fistula via hepatoduodenal ligament secondary to gangrenous cholecystitis: a case report. Surg Case Rep 2022; 8:201. [PMID: 36272011 PMCID: PMC9588128 DOI: 10.1186/s40792-022-01557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cholecystoduodenal fistula is an infrequent complication of gallbladder diseases. In the majority of cases, the fistula is formed by direct communication between the gallbladder and duodenum due to gallstone impaction in the gallbladder neck. We herein report a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis. CASE PRESENTATION An 80-year-old woman suspected of having emphysematous cholecystitis by a previous doctor was referred to our hospital for urgent surgery. The initial diagnosis based on additional examinations was gangrenous cholecystitis penetrating the hepatoduodenal ligament. Since she did not complain of signs of peritonitis and was taking an anticoagulant medicine, we avoided surgery and selected percutaneous gallbladder drainage (PTGBD) instead. Contrast imaging of the PTGBD tube and upper endoscopy identified the indirect cholecystoduodenal fistula via the hepatoduodenal ligament. Despite repeated attempts at endoscopic fistula closure using clips, the fistula did not close successfully. We therefore performed laparoscopic cholecystectomy and fistula closure. The postoperative clinical course was uneventful, and she left the hospital on postoperative day 15. The resected gallbladder contained small black stones, and a histological examination revealed gangrenous cholecystitis with no malignant signatures. CONCLUSION We encountered a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis that was successfully treated by laparoscopic cholecystectomy and fistula closure. It is important to recognize the possible formation of indirect cholecystoduodenal fistula in cases of gangrenous cholecystitis penetrating the hepatoduodenal ligament.
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Affiliation(s)
- Yasunari Fukuda
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Toshiya Michiura
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Daisaku Ito
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Tomohiro Takahashi
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Shinji Tokuyama
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Hiromu Morishita
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Junya Nuta
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Yasuaki Miyazaki
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Nobuyasu Hayashi
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Kazuo Yamabe
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
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15
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Huang SF, Han YH, Chen J, Zhang J, Huang H. Surgical Management of Cholecystoenteric Fistula in Patients With and Without Gallstone Ileus: An Experience of 29 Cases. Front Surg 2022; 9:950292. [PMID: 35874133 PMCID: PMC9304664 DOI: 10.3389/fsurg.2022.950292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/24/2022] [Indexed: 12/17/2022] Open
Abstract
Background Cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis. Here, we report our experience on diagnostic methods and surgical management of CEF patients with and without gallstone ileus (GI). Methods This is a retrospective cases series over an 11-year period (2011–2022). Data analyzed included preoperative characteristics, ultrasound, imaging features, operation findings and postoperative course. Results A total of 29 patients diagnosed with CEF were enrolled, 51.7% (15/29) of whom were female, with a median age of 66 years (range: 35–96 years). With regards to subtype distribution, seventeen patients had cholecystoduodenal fistula (CDF), six had cholecystoconlonic fistula (CCF), three exhibited cholecystogastric fistula (CGF), one CDF combination with CCF and two CDF combination with type I Mirizzi syndrome. Twelve patients presented with gallstone ileus, and received one stage procedure or simple Enterolithotomy. The median operation time and blood loss of 157 min (range: 65–360 min) and 40 ml (range: 10–450 ml), respectively. Surgical complications, evidenced by fistula recurrence, were recorded in three patients (3/22; 13.6%), while four (4/29; 13.8%) and one patient (1/29; 3.4%) presented with wound infection and residual stone in common bile duct, respectively. No deaths were reported in our study. Conclusion CEF is a rare complication of gallstone disease that is occasionally found during operation. To date, no consensus has been reached regarding efficacious treatment therapies for CEF patients. For a CEF patient with GI, one stage procedure should be selected prudently, while simple Enterolithotomy would be a mainstream choice for relieving bowel obstruction.
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16
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Lee CK, Ramcharan DN, Alaimo KL, Velez V, Risden AE, Klein DH, Garcia O, Joshi V, Jorge JM. Cholecystoduodenal Fistula Evading Imaging and Endoscopic Retrograde Cholangiopancreatography: A Case Report. Cureus 2021; 13:e20049. [PMID: 34987929 PMCID: PMC8717936 DOI: 10.7759/cureus.20049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
Cholecystoduodenal fistulas are a type of internal biliary fistula that occur due to chronic inflammation of the gallbladder/biliary tree; if left untreated, perforation and necrosis can occur. Cholecystoduodenal fistulas are often difficult to diagnose due to their non-specific signs and symptoms. Since the widespread use of techniques such as magnetic resonance cholangiopancreatography and imaging modalities such as computed tomography, the frequency of reports describing intraoperative cholecystoduodenal fistula has reduced dramatically. Here, we report the case of a 54-year-old female who presented with a two-day history of non-radiating epigastric abdominal pain, initially diagnosed with acute cholecystitis and choledocholithiasis. Upon undergoing laparoscopic cholecystectomy, she was found to have extensive fibrosis of the gallbladder, adhesions, and an impacted gallstone in the wall of the gallbladder. Imaging and endoscopic retrograde cholangiopancreatography performed prior to surgery did not detect a cholecystoduodenal fistula that was discovered intraoperatively. She was treated successfully with laparoscopic cholecystectomy and repair of the duodenum.
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Affiliation(s)
- Charles K Lee
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Darren N Ramcharan
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Kayla L Alaimo
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Veronica Velez
- Surgery, West Suburban Medical Center, Oak Park, USA
- Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Anika E Risden
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Dhadon H Klein
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Osbaldo Garcia
- Internal Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Vaidehi Joshi
- Medicine, Avalon University School of Medicine, Willemstad, CUW
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Juaquito M Jorge
- General and Bariatric Surgery, West Suburban Medical Center, Oak Park, USA
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17
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Brown KK, Cunningham KJ, Howell A, Vance JE. A Rare Case of Cholecystoduodenal Fistula with Rapid Distal Gallstone Migration. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929150. [PMID: 33872294 PMCID: PMC8063766 DOI: 10.12659/ajcr.929150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patient: Female, 51-year-old Final Diagnosis: Cholecystoduodenal fistula Symptoms: Nausea • non-bilious emesis • right upper quadrant abdominal pain Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Kayla K Brown
- College of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Kyle J Cunningham
- College of Osteopathic Medicine, Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Adam Howell
- Department of General Surgery, Ascension Michigan Genesys Hospital, Grand Blanc, MI, USA
| | - John Edward Vance
- Department of General Surgery, Ascension Michigan Genesys Hospital, Grand Blanc, MI, USA
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18
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Severe complications of chronic cholelithiasis treatment. Am J Emerg Med 2021; 48:374.e5-374.e12. [PMID: 33773867 DOI: 10.1016/j.ajem.2021.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require emergency care. Severe complications are not uncommon and require special attention, as lethal outcome is possible. CASE PRESENTATION We present a retrospective analysis of eight cases describing severe complications of gallstones in patients undergoing endoscopic treatment of chronic gallstones conditions. All patients were admitted to our emergency care department following symptoms onset. The diagnostic difficulties, treatment strategies and outcomes are presented. The associated risk factors and preventative measures are discussed. Two patients developed profuse bleeding, two developed acute pancreatitis, two patients had perforation related complications. One rare case of bilioma and one case of iatrogenic injury are presented. All patients had severe condition, in two cases lethal outcome was a result of co-morbidity and difficulties in management. CONCLUSION Special care should be taken in patients with risk factors of severe complications in order to improve outcome and prevent the development of life-threatening conditions.
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19
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Aamery A, Pujji O, Mirza M. Operative management of cholecystogastric fistula: case report and literature review. J Surg Case Rep 2019; 2019:rjz345. [PMID: 31824641 PMCID: PMC6893000 DOI: 10.1093/jscr/rjz345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 08/22/2019] [Accepted: 10/24/2019] [Indexed: 12/27/2022] Open
Abstract
We present a patient who was managed surgically for cholecystogastric fistula. The patient was presented with nonspecific symptoms (upper abdominal pain, belching) and, after being investigated, was proceeded for laparoscopic cholecystectomy for gallbladder stones. Unexpectedly, intraoperative, she was found to have cholecystogastric fistula, which was operated with open single-stage approach. We highlight the incidence of these cases, the difficult preoperative clinical presentation and possible diagnostic imaging; explain further about the different surgical approaches to manage these cases and finally review the literature regarding the presentation and the management of bilioenteric fistulas.
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Affiliation(s)
- Amaar Aamery
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Ojas Pujji
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Muhammad Mirza
- New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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20
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Kim DH, Kim TH, Kim CW, Chang JH, Han SW, Kim JK, Lee SH, Kim J. A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Dong Hwi Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Tae Ho Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Chang Whan Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sok Won Han
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Kwang Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Seung Hwan Lee
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeana Kim
- Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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21
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Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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22
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Aguilar-Espinosa F, Maza-Sánchez R, Vargas-Solís F, Guerrero-Martínez GA, Medina-Reyes JL, Flores-Quiroz PI. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:287-295. [PMID: 28389051 DOI: 10.1016/j.rgmx.2016.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/02/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bilioenteric fistulas are the abnormal communication between the bile duct system and the gastrointestinal tract that occurs spontaneously and is a rare complication of an untreated gallstone in the majority of cases. These fistulas can cause diverse clinical consequences and in some cases be life-threatening to the patient. AIM To identify the incidence of bilioenteric fistula in patients with gallstones, its clinical presentation, diagnosis through imaging study, surgical management, postoperative complications, and follow-up. MATERIALS AND METHODS A retrospective study was conducted to search for bilioenteric fistula in patients that underwent cholecystectomy at our hospital center due to cholelithiasis, cholecystitis, or cholangitis, within a 3-year time frame. RESULTS Four patients, 2 men and 2 women, were identified with cholecystoduodenal fistula. Their mean age was 81.5 years. Two of the patients presented with acute cholangitis and 2 presented with bowel obstruction due to gallstone ileus. All the patients underwent surgical treatment and the diagnostic and therapeutic management of each of them was analyzed. CONCLUSIONS The incidence of cholecystoduodenal fistula was similar to that reported in the medical literature. It is a rare complication of gallstones and its diagnosis is difficult due to its nonspecific symptomatology. It should be contemplated in elderly patients that have a contracted gallbladder with numerous adhesions.
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Affiliation(s)
- F Aguilar-Espinosa
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México.
| | - R Maza-Sánchez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - F Vargas-Solís
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - G A Guerrero-Martínez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - J L Medina-Reyes
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - P I Flores-Quiroz
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
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23
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Jung HI, Ahn T, Cho SW, Bae SH, Lee MS, Kim CH. Incidental cholecystojejunal fistula treated with successful laparoscopic management. Ann Surg Treat Res 2014; 87:276-8. [PMID: 25368855 PMCID: PMC4217258 DOI: 10.4174/astr.2014.87.5.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/04/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022] Open
Abstract
Internal biliary fistula (IBF) is occurred spontaneously due to the biliary disease in most cases. Bilioenteric, biliobiliary, bronchobiliary, and vasculobiliary type of IBF have been reported in the literature. We herein describe our experience with an incidental cholecystojejunal fistula, a very rare type of bilioenteric fistula in laparoscopic cholecystectomy. A 61-year-old woman with several years' history of intermittent right upper abdominal pain was admitted to Soonchunhyang University Cheonan Hospital. Abdominal CT scan showed the pneumobilia in gallbladder with common bile duct dilatation. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were done. On operative findings, there was a cholecystojejunal fistula. We performed laparoscopic cholecystectomy and fistulectomy with jejunal partial resection. To our knowledge, this is the first report on incidental cholecystojejunal fistula uncombined with any other disease and was treated with laparoscopic procedure.
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Affiliation(s)
- Hae Il Jung
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Taesung Ahn
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung Woo Cho
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sang Ho Bae
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Moon Soo Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Chang Ho Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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24
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-267. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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25
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Abstract
Recent advances in hepatobiliary imaging techniques have led to the increased detection of choledochoduodenal fistula. However, the diagnosis and treatment of choledochoduodenal fistula is still a challenge. In this study, we summarize how patients were diagnosed and treated for choledochoduodenal fistula at our institution. Sixty-six patients with choledochoduodenal fistula were diagnosed and treated in our department from January 2000 to June 2009. Sixty-one patients were treated operatively, whereas five patients were treated with medicine. Patients with choledochoduodenal fistula were confirmed by endoscopic retrograde cholangiography. Of the 61 patients needing surgical intervention, clinical outcomes were excellent in 57 patients, and five patients underwent successful laparoscopic surgery for repairing the choledochoduodenal fistula. Follow-up of these patients for 6 months to 10 years showed they did not suffer from further cholangitis. A patients’ past history of biliary disease, upper abdominal pain, fever, and jaundice may lead to choledochoduodenal fistula. Operative therapy, including laparoscopic surgery, was the primary treatment for most patients, regardless of the preoperative diagnosis.
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Affiliation(s)
- Kai-Can Zong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai-Bo You
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian-Ping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Tu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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26
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Savvidou S, Goulis J, Gantzarou A, Ilonidis G. Pneumobilia, chronic diarrhea, vitamin K malabsorption: A pathognomonic triad for cholecystocolonic fistulas. World J Gastroenterol 2009; 15:4077-82. [PMID: 19705508 PMCID: PMC2731963 DOI: 10.3748/wjg.15.4077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.
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