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.

A Case of Choledocho-Duodeno-Colonic Fistula / 대한소화기내시경학회지

Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto-duodenal fistula, yet the combination of choledocho-duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures.

A case of choledochogastric fistula accompanying epigastric pain / 대한내과학회지

Biliary enteric fistula is fistulous communication between the biliary tract and the gastrointestinal tract due to gallstones, peptic ulcer, malignancy and trauma. The types of fistulas are cholecystoduodenal, cholecystocolonic, choledochoduodenal, cholecystogastric and very rare choledochogastric. The preoperative diagnosis is difficult because their symptoms are usually nonspecific. Pneumobilia on plain film of the abdomen has been considered as a clue. Reflux of contrast media into the biliary tree during a barium study or an endoscopic retrograde cholangiopancreatography is most suggestive finding. We experienced a case of spontaneous choledochogastric fistula. A 62-year-old man was admitted to Chungbuk National University Hospital with epigastric pain. A 5 mm sized orifice of fistula on the prepyloric antrum of the stomach was observed on gastroscopy. Abdominal computed tomography scan showed pneumobilia in the intrahepatic duct of the liver. Upper gastrointestinal series showed the contrast media leaking from the posterior wall of antrum of the stomach into the common bile duct.

Íleo biliar: enterolitotomia videoassistida / Gallstone ileus: videoassisted enterolithotomy

Treatment, morbidity and mortality of patients with gallstone ileus depend on an accurate diagnosis made in time, and also on a more adequate therapeutic option.A detailed clinical evaluation is fundamental for such diagnosis. Complementary exams like a simple radiological study of the abdomen, high and low endoscopies, an ultrasonography, and a tomography can also be performed. The therapeutic options include the removal of the obstructive factor separately, the performance of a treatment in two separate stages, or the performance of a complete treatment (removal of the calculus, cholecystectomy, and the closing of the fistula).This study aims to present a case report of an elderly man of high surgical risk, presenting gallstone ileus. He was submitted to an isolated videoassisted enterolithotomy through a minilaparotomy. Taking into consideration the patient’s advanced age and the lack of evidence as to other biliary associated pathologies, the chosen treatment seemed to be a good alternative. The evolution was good, and after an 8 month follow-up the patient was found well and with no biliary symptoms whatsoever.

A Case of Asymptomatic Cholecystogastric Fistula / 대한소화기내시경학회지

Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction.