Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5846-5853
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5846
Spontaneous gallbladder perforation and colon fistula in hypertriglyceridemia-related severe acute pancreatitis: A case report
Qi-Pu Wang, Yi-Jun Chen, Mei-Xing Sun, Jia-Yuan Dai, Jian Cao, Qiang Xu, Guan-Nan Zhang, Sheng-Yu Zhang
Qi-Pu Wang, Yi-Jun Chen, Mei-Xing Sun, Sheng-Yu Zhang, Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
Yi-Jun Chen, School of Medicine, Tsinghua University, Beijing 100084, China
Jia-Yuan Dai, Department of Emergency Medicine, Peking Union Medical College Hospital, Beijing 100730, China
Jian Cao, Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
Qiang Xu, Guan-Nan Zhang, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Wang QP and Chen YJ were the patient’s gastroenterologists, reviewed the literature, and contributed to manuscript drafting; Sun MX was the patient’s gastroenterologist; Dai JY was the patient’s emergency doctor; Cao J interpreted the imaging findings and performed the percutaneous drainage; Xu Q and Zhang GN performed all surgeries; Zhang SY was the patient’s gastroenterologist and was responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by Beijing Science and Technology Program, No. Z181100001618013; and Peking Union Medical College Education Reform Program, No. 2019zlgc0116.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Dr. Zhang reports grants from Beijing Science and Technology Program, grants from Peking Union Medical College Education Reform Program, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Yu Zhang, MD, Doctor, Department of Gastroenterology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. pumchzsy@126.com
Received: December 23, 2021
Peer-review started: December 23, 2021
First decision: January 27, 2022
Revised: February 2, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
Abstract
BACKGROUND

Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis (SAP). However, neither spontaneous gallbladder perforation nor cholecysto-colonic fistula has been reported in acalculous acute pancreatitis patients.

CASE SUMMARY

A 31-year-old male presenting with epigastric pain was diagnosed with hypertriglyceridemia-related SAP. He suffered from multiorgan failure and was able to leave the intensive care unit on day 20. Three percutaneous drainage tubes were placed for profound exudation in the peripancreatic region and left paracolic sulcus. He developed spontaneous gallbladder perforation with symptoms of fever and right upper quadrant pain 1 mo after SAP onset and was stabilized by percutaneous drainage. Peripancreatic infection appeared 1 mo later and was treated with antibiotics but without satisfactory results. Then multiple colon fistulas, including a cholecysto-colonic fistula and a descending colon fistula, emerged 3 mo after the onset of SAP. Nephroscopy-assisted peripancreatic debridement and ileostomy were carried out immediately. The fistulas achieved spontaneous closure 7 mo later, and the patient recovered after cholecystectomy and ileostomy reduction. We presume that the causes of gallbladder perforation are poor bile drainage due to external pressure, pancreatic enzyme erosion, and ischemia. The possible causes of colon fistulas are pancreatic enzymes or infected necrosis erosion, ischemia, and iatrogenic injury. According to our experience, localized gallbladder perforation can be stabilized by percutaneous drainage. Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.

CONCLUSION

Gallbladder perforation and cholecysto-colonic fistula should be considered in acalculous SAP patients.

Keywords: Acalculous severe acute pancreatitis, Gallbladder perforation, Cholecysto-colonic fistula, Percutaneous drainage, Cholecystectomy, Case report

Core Tip: To the best of our knowledge, this is the first time that spontaneous gallbladder perforation and cholecysto-colonic fistula have been reported in patients with acalculous severe acute pancreatitis. Biliary obstruction due to peripancreatic effusions, pancreatic enzymes or infected necrosis erosion, ischemia, and iatrogenic injury might be related. According to our experience, localized gallbladder perforation can be stabilized by percutaneous drainage. Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.