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Ng DWK, Tan HJ, Thiruchelvam N, Chiow AKH. Laparoscopic approach to cholecystoenteric fistula: A single-centre experience and systematic review. Am J Surg 2025; 245:116348. [PMID: 40300395 DOI: 10.1016/j.amjsurg.2025.116348] [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: 12/23/2024] [Revised: 03/24/2025] [Accepted: 04/10/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Cholecystoenteric fistula (CEF) is a rare but well recognized complication of gallstones. Traditionally, surgical management was by open approach. We aim to report on the safety and outcomes of laparoscopic surgery for CEF and present a systematic review of literature. METHODS All patients who underwent laparoscopic cholecystectomy in our institution from January 2015 to December 2023 were retrospectively reviewed. We identified all patients with CEF for data collection, including demographics, clinical presentation, operative details, and outcomes. Systematic review of literature reporting on safety and outcomes of laparoscopic surgery for CEF was performed. RESULTS 4937 patients underwent laparoscopic cholecystectomy over a nine-year period between January 2015 to December 2023.19 patients were diagnosed with CEF. Mean age was 63.7 years. 14 patients (73.7 %) were diagnosed intra-operatively. Pneumobilia was a key radiological feature leading to pre-operative diagnosis in three patients. Laparoscopic surgical stapler was most common fistula closure method with six cases (31.6 %), followed by laparoscopic handsewn closure in five patients (26.3 %). Open conversion rate was 36.8 %. Three patients (15.8 %) had minor complications, and one patient (5.3 %) had bile leak. There was one 30-day readmission. There were zero mortalities in our cohort. Median time to diet and length of stay was 2.5 and 6 days respectively. Following exclusions, the systematic review identified seven studies with a total of 145 patients. Major complication rate was 2.8 % and mortality 1.4 % among those included. CONCLUSION Laparoscopic surgery is safe and feasible in management of cholecystoenteric fistula. It has good outcomes in surgeons familiar with laparoscopic skills.
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Affiliation(s)
- Daniel Wee Kiat Ng
- Hepatopancreatobiliary Service, Department of Surgery, Changi General Hospital, Singapore
| | - Hiang Jin Tan
- Hepatopancreatobiliary Service, Department of Surgery, Changi General Hospital, Singapore; Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Nita Thiruchelvam
- Hepatopancreatobiliary Service, Department of Surgery, Changi General Hospital, Singapore; Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Adrian Kah Heng Chiow
- Hepatopancreatobiliary Service, Department of Surgery, Changi General Hospital, Singapore; Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore.
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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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Azami T, Takano Y, Tamai N, Noda J, Yamawaki M, Niiya F, Nishimoto F, Maruoka N, Ogawa T, Nagahama M. Intracholecystic papillary neoplasm associated with an invasive carcinoma with cholecystocolonic fistula: a case report. Clin J Gastroenterol 2025; 18:188-194. [PMID: 39668313 DOI: 10.1007/s12328-024-02079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/28/2024] [Indexed: 12/14/2024]
Abstract
Intracholecystic papillary neoplasm and cholecystocolonic fistula are both relatively rare diseases. Here, we report a case of a preoperative intracholecystic papillary neoplasm associated with invasive carcinoma and a transverse colonic fistula of the gallbladder. A 79-year-old female patient presented to our hospital with persistent right upper quadrant pain for several months and was suspected to have intracholecystic papillary neoplasm associated with an invasive carcinoma by computed tomography and endoscopic ultrasound. A gallbladder tumor biopsy was pathologically diagnosed as intracholecystic papillary neoplasm. Preoperative cholecystocolonic fistula diagnosis enabled planning not only for cholecystectomy, but also for transverse colon partial resection. Pathological examination of the resected specimen revealed intracholecystic papillary neoplasm associated with an invasive carcinoma with subserosal invasion. No malignant findings were observed in the fistula. This is a rare condition, but the presence or absence of cholecystocolonic fistula should be considered before performing intracholecystic papillary neoplasm surgery.
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Affiliation(s)
- Tetsushi Azami
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan.
| | - Yuichi Takano
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Naoki Tamai
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Jun Noda
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Masataka Yamawaki
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Fumitaka Niiya
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Fumiya Nishimoto
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
| | - Takafumi Ogawa
- Department of Diagnostic Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan
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Konstantinoff KS, Ludwig DR, Sharbidre K, Arif-Tiwari H, Itani M. Gallbladder and biliary pathology: lessons learned from multidisciplinary conference. Abdom Radiol (NY) 2025; 50:916-935. [PMID: 39259353 DOI: 10.1007/s00261-024-04533-z] [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] [Received: 06/28/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
The radiologic diagnosis of biliary disease can be challenging due to atypical or delayed presentation, rare or less common entities, and imaging overlap of benign and malignant processes. Establishing a specific diagnosis, when possible, is important to avoid progression of infections to sepsis and multiorgan failure, and for appropriate staging and management in cases of malignancy. Gallstones are the most common biliary disease, and along with stone-related complications, including cholecystitis and choledocholithiasis, constitute the majority of acute biliary pathology. Late and atypical manifestations of acute cholecystitis demonstrate imaging overlap with primary gallbladder cholangiocarcinoma, especially with cases of exuberant inflammatory reaction such as xanthogranulomatous cholecystitis. Additional challenging scenarios related to gallbladder disease, that may be benign or malignant, include adjacent fistulas and lymphadenopathy. Dropped gallstones, especially in atypical locations, may be misdiagnosed as neoplastic. Recurrent cholecystitis after cholecystectomy, whether related to subtotal cholecystectomy or to stumpitis, is another entity that can be confusing to the radiologist with a documented history of cholecystectomy. Inflammatory and autoimmune conditions, such as pseudotumors and IgG4 disease, are a less common but not infrequent cause of diagnostic dilemma. Furthermore, biliary strictures and hepatobiliary cystic lesions can be benign or malignant and could constitute a diagnostic and management challenge. The goal of this manuscript is to present the lessons learned from multidisciplinary conferences on the above entities and suggest tips and pearls to maximize the value of radiologists' contribution to patient management.
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Affiliation(s)
- Katerina S Konstantinoff
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA
| | - Kedar Sharbidre
- Department of Radiology, University of Alabama in Birmingham, 500 22nd Street South, Birmingham, AL, 35233, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell, Tucson, AZ, 85724, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA.
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5
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Hassine HB, Ouertani F, Chaouch MA, Jallali M, Jabra SB, Noomen F. Operative management of cholecystogastric fistula as a rare complication of gallbladder empyema: A case report. Int J Surg Case Rep 2024; 125:110515. [PMID: 39509829 PMCID: PMC11577169 DOI: 10.1016/j.ijscr.2024.110515] [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: 08/06/2024] [Revised: 10/21/2024] [Accepted: 10/23/2024] [Indexed: 11/15/2024] Open
Abstract
INTRODUCTION Cholecysto-gastric fistula is a rare, life-threatening complication of cholelithiasis that presents significant challenge to surgeons. Early diagnosis can be obtained and surgical intervention can be planned as elective case. Dilemma comes when patient presenting with acute acute abdominal symptoms necessitating immediate surgery, decision-making becomes more complex increasing morbidity and mortality. PRESENTATION OF CASE A 59-year-old gentleman, was admitted for acute epigastric and right hyochondrium pain along with fever persisting for one week. The diagnosis of gallbladder empyema was retained. Emergency laparotomy revealed a cholecysto-gastric fistula, an inter hepatico-diaphragmatic abscess, and acute gangrenous cholecystitis. Surgical intervention included drainage of the abscess, cholecystectomy with placement of a trans-cystic drain, closure of the cholecysto-gastric fistula, and contact drainage. DISCUSSION Cholecystogastric fistula a rare, life-threatening complication of cholelithiasis, The pathogenesis underlying is complicated. Despite improvements in imaging techniques, diagnosing remains challenging is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. The surgical management of cholecysto-enteric fistulas remains a contentious issue, with many surgeons favoring conversion to an open approach over laparoscopic surgery. CONCLUSION Cholecystogastric fistula, although rare, is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. Advances in radiological and endoscopic techniques facilitate accurate and timely diagnosis, enabling the planning of appropriate surgical management. This brief report sheds light on the importance of a multidisciplinary team preventing a potentially fatal outcome.
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Affiliation(s)
- Hiba Ben Hassine
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Ferdaous Ouertani
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Maissa Jallali
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Sadek Ben Jabra
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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6
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Hens B, Reynaert H. Cholecystocolonic Fistula: A Case of Chronic Diarrhoea and Hidden Stones. Cureus 2024; 16:e73129. [PMID: 39650932 PMCID: PMC11623043 DOI: 10.7759/cureus.73129] [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: 11/06/2024] [Indexed: 12/11/2024] Open
Abstract
A cholecystocolonic fistula (CCF) is a rare cause of chronic diarrhoea. It most often occurs in elderly women as a result of chronic inflammation due to gallstone disease or, rarely, malignancy. Curative treatment consists of cholecystectomy with excision of the fistula tract, but it is often overlooked preoperatively and thus entails a higher risk of postoperative complications. Here, we present a case of a 78-year-old woman with chronic diarrhoea who was diagnosed with a CCF during a colonoscopy. Cholecystectomy was complicated by acute cholangitis due to an obstructive stone in the common bile duct (CBD) that was masked preoperatively due to alternative biliary drainage via the CCF. Recognition of this rare entity can enhance clinicians' diagnostic appraisal and limit postoperative complications.
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Affiliation(s)
- Brecht Hens
- Gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Brussels, BEL
| | - Hendrik Reynaert
- Gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Brussels, BEL
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7
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Thariq Ajmal I, Anand F, Selvam P, Muralidhar V. Cholecystocolonic fistula: an incidental intraoperative discovery managed laparoscopically. BMJ Case Rep 2024; 17:e262430. [PMID: 39455077 DOI: 10.1136/bcr-2024-262430] [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: 10/28/2024] Open
Abstract
Cholecystoenteric fistula is a rare complication of cholelithiasis, occurring in 3%-5% of patients with cholelithiasis. The symptoms are typically minimal and vague, with either acute or subacute presentations, rarely leading to bowel obstruction, and occasionally manifesting as chronic abdominal pain. In this case, a male patient in his early 30s presented with epigastric and right hypochondrial pain. On evaluation, he was diagnosed with gallstone disease and adenomyomatosis of the gallbladder. During laparoscopic cholecystectomy, a cholecystocolonic fistula was unexpectedly discovered. The fistula was managed laparoscopically using ENDOLOOP (prelooped chromic catgut ligature) ligation of the fistulous tract. The patient recovered without complications and was discharged on the third postoperative day. This case emphasises the importance of intraoperative vigilance and demonstrates a successful minimally invasive management approach.
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Affiliation(s)
- Imran Thariq Ajmal
- Department of General Surgery, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
| | - Felix Anand
- Department of General Surgery, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
| | - Pavithra Selvam
- Department of General Surgery, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India
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8
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Bhojani F, Ahmed Memon W, Ahmad MN, Muhammad Zohaib Uddin M, Khan S, Nadeem N, Khan F, Zafar U. Cholecystocolonic fistula secondary to ascending colon diverticular disease: A case report. Clin Case Rep 2024; 12:e9405. [PMID: 39296474 PMCID: PMC11408266 DOI: 10.1002/ccr3.9405] [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: 04/09/2024] [Revised: 07/18/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
Cholecystocolonic fistula occurring as a complication of colonic diverticular disease is a rarely encountered clinical entity in which the patient may remain asymptomatic or present with vague abdominal or systemic symptoms. Imaging studies are usually not very reliable or effective in detecting direct communication between gallbladder and colon. However, indirect signs such as pneumobilia, gallstones, gallbladder adherent to colon and colonic diverticulosis may help reach the diagnosis. Treatment of cholecystocolonic fistula in symptomatic patients is usually surgical. However, in asymptomatic patients or patients with risk factors and comorbidities, non-surgical options such as conservative management or biliary stenting can be considered.
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Affiliation(s)
- Fatima Bhojani
- Radiology Department Aga Khan University Hospital Karachi Pakistan
| | | | | | | | - Sibgha Khan
- Radiology Department National Medical Center Karachi Pakistan
| | - Naila Nadeem
- Radiology Department Aga Khan University Hospital Karachi Pakistan
| | - Faheemullah Khan
- Section of Cardiovascular Imaging, Radiology Department, Diagnostic Institute Cleveland Clinic, Main Campus Cleavland Ohio USA
| | - Uffan Zafar
- Radiology Department Aga Khan University Hospital Karachi Pakistan
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9
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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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10
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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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11
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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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12
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Cozma MA, Găman MA, Srichawla BS, Dhali A, Manan MR, Nahian A, Marsool MDM, Suteja RC, Kutikuppala LVS, Kipkorir V, Găman AM, Diaconu CC. Acute cholangitis: a state-of-the-art review. Ann Med Surg (Lond) 2024; 86:4560-4574. [PMID: 39118745 PMCID: PMC11305776 DOI: 10.1097/ms9.0000000000002169] [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: 01/24/2024] [Accepted: 05/05/2024] [Indexed: 08/10/2024] Open
Abstract
Acute cholangitis is a potentially life-threatening bacterial infection of the intra and/or extrahepatic bile ducts. It remains the second and third cause of community-acquired and hospital-acquired bacteremia, respectively, and is associated with mortality rates of up to 15%, despite advances in broad-spectrum antimicrobial therapy and improved access to emergency biliary tract decompression procedures. Even though not much has changed in recent years in terms of diagnosis or treatment, new data have emerged regarding multidrug-resistant bacteria that serve as etiologic agents of cholangitis. Moreover, different approaches in antibiotic regimes depending on severity grading and bile sample cultures as well as novel minimally invasive endoscopic procedures that can help when consecrated treatments such as endoscopic retrograde cholangiopancreatography (ERCP) fail, cannot be performed, or are unavailable have been proposed. This state-of-the-art review aims to offer a complete and updated assessment of the epidemiology, novel diagnostic and therapeutic methods, complications, and prognostic variables of acute cholangitis. The authors will review the prognostic implications of unusual complications, the relevance of regular bile samples and antibiograms, and their new role in guiding antibiotic therapy and limiting antibiotic resistance to present an organized and comprehensive approach to the care of acute cholangitis.
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Affiliation(s)
- Matei-Alexandru Cozma
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest
| | - Bahadar S. Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA
| | - Arkadeep Dhali
- NIHR Academic Clinical Fellow in Gastroenterology, University of Sheffield; Internal Medicine Trainee, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Ahmed Nahian
- Medical Student, LECOM at Seton Hill, Greensburg, PA, USA
| | | | | | | | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Amelia Maria Găman
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova
- Clinic of Hematology, Filantropia City Hospital, Craiova, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest
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13
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Khan O, Singh K, Kumar NS, Kumar N, Basu S. Duodenocolic and Cholecystocolonic Fistula: A Case Report of an Unusual Presentation. Cureus 2024; 16:e56445. [PMID: 38638764 PMCID: PMC11024872 DOI: 10.7759/cureus.56445] [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: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Laparoscopic cholecystectomy is the established standard of care for addressing symptomatic gallstones, typically representing a straightforward and uncomplicated surgical procedure. However, patients exhibiting variant anatomy or local inflammation can present challenges to the surgeon, potentially leading to complications. In this context, we present the case of a 55-year-old woman who underwent a laparoscopic cholecystectomy for symptomatic gallstone disease at a different medical facility. Postoperatively, she was diagnosed with a case of duodenocolic fistula and cholecystocolonic fistula. Conservative treatment ensued with intravenous antibiotic administration, as well as enteral and parenteral feeding. Diagnosing cholecystocolonic fistula before surgery proves challenging, even with modern diagnostic and imaging tools. Despite its significance, there is limited information in the literature regarding the management of this infrequent finding. The approach to diagnosis and management is elaborated upon in the case report.
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Affiliation(s)
- Ozair Khan
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Karamveer Singh
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Nayana S Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Navin Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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14
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Wang CY, Chiu SH, Chang WC, Ho MH, Chang PY. Cholecystoenteric fistula in a patient with advanced gallbladder cancer: A case report and review of literature. World J Clin Cases 2023; 11:8519-8526. [PMID: 38188217 PMCID: PMC10768506 DOI: 10.12998/wjcc.v11.i36.8519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Cholecystoenteric fistula (CEF) involves the formation of a spontaneous anomalous tract between the gallbladder and the adjacent gastrointestinal tract. Chronic gallbladder inflammation can lead to tissue necrosis, perforation, and fistulogenesis. The most prevalent cause of CEF is chronic cholelithiasis, which rarely results from malignancy. Because the symptoms and laboratory findings associated with CEF are nonspecific, the condition is often misdiagnosed, presenting a challenge to the surgeon when detected intraoperatively. Therefore, a preoperative diagnosis of CEF is crucial. CASE SUMMARY We present the case of a 57-year-old male with advanced gallbladder cancer (GBC) who arrived at the emergency room with persistent vomiting, abdominal pain, and diarrhea. An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second portion of the duodenum and transverse colon. We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula (CDF) or a cholecystocolonic fistula (CCF). He underwent multiple examinations, including esophagogastroduodenoscopy, an upper gastrointestinal series, colonoscopy, and magnetic resonance cholangiopancreatography; the results of these tests confirmed a diagnosis of synchronous CDF and CCF. The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon. His symptoms improved with supportive treatment while hospitalized. He initiated oral targeted therapy with lenvatinib for further anticancer treatment. CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
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Affiliation(s)
- Chun-Yu Wang
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Sung-Hua Chiu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Meng-Hsing Ho
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ping-Ying Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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15
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Gómez Otero M, Valdivielso Cortázar E, Miñones Ginarte C, Madarnás Alonso L, Pérez Vior L, Couto Wörner I, Souto Ruzo J, Alonso Aguirre PA. Cholecystogastric fistula diagnosed by endoscopic ultrasonography. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:749-750. [PMID: 37771296 DOI: 10.17235/reed.2023.9915/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
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Affiliation(s)
| | | | | | | | - Lucía Pérez Vior
- Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña
| | | | - José Souto Ruzo
- Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña
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16
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Zippi M, Toma A, Hong W, Fiorino S, Grottesi A. A rare gastrointestinal bleeding due to a cholecystoduodenal fistula: a case report. EGYPTIAN LIVER JOURNAL 2023; 13:55. [DOI: 10.1186/s43066-023-00292-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/02/2023] [Indexed: 01/03/2025] Open
Abstract
Abstract
Background
Gastrointestinal bleeding from cholecystoduodenal fistula is rare. It is usually managed surgically, although a conservative approach is reported in isolated cases.
Case presentation
A 71-year-old male patient was admitted to the emergency department (ED) presenting melena associated with severe anemia, requiring a blood transfusion. An urgent upper endoscopy showed the intestinal orifice of a cholecystoduodenal fistula. This finding was confirmed by radiological examination and laparoscopy. Cholecystectomy and simultaneous excision of the fistula were successfully performed. As a result, a diagnosis of Mirizzi syndrome type Va was also made.
Conclusion
A cholecystoduodenal fistula orifice leading to gastrointestinal bleeding is difficult to diagnose without an endoscopic examination of the upper digestive tract. Following this first diagnostic step, a comprehensive patient examination should be conducted, specifically if a history of gallbladder lithiasis has been reported.
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17
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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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18
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Quiroga-Garza A, Alvarez-Villalobos NA, Muñoz-Leija MA, Garcia-Campa M, Angeles-Mar HJ, Jacobo-Baca G, Elizondo-Omana RE, Guzman-Lopez S. Gallbladder perforation with fistulous communication. World J Gastrointest Surg 2023; 15:1191-1201. [PMID: 37405089 PMCID: PMC10315112 DOI: 10.4240/wjgs.v15.i6.1191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial.
AIM To recommend management options for GBP with fistulous communication.
METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication.
RESULTS A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed.
CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.
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Affiliation(s)
- Alejandro Quiroga-Garza
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- General Surgery Division, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Neri Alejandro Alvarez-Villalobos
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- Family Medicine Division, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Milton Alberto Muñoz-Leija
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- Surgery Division, Hospital General de Zona No. 6, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Mariano Garcia-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | - Hermilo Jeptef Angeles-Mar
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | - Guillermo Jacobo-Baca
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | | | - Santos Guzman-Lopez
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
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19
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Muñoz Leija MA, Alemán-Jiménez MC, Plata-Álvarez H, Cárdenas-Salas VD, Valdez-López R. Laparoscopic Management of Cholecystoduodenal and Cholecystocolic Fistula: A Clinical Case Report. Cureus 2023; 15:e40657. [PMID: 37476135 PMCID: PMC10356180 DOI: 10.7759/cureus.40657] [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: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Biliary fistula is a rare (less than 8%) cholecystectomy complication, internal fistulae being the most common of them (mainly colonic and duodenal). However, the presence of two fistulas at the same time is extremely rare, with a small number of cases reported in the literature to date. Symptoms tend to be non-specific, leading to a difficult preoperative diagnosis. The standard treatment for bilioenteric fistulas is open cholecystectomy and subsequent closure of the fistula. Nonetheless, modern techniques including laparoscopic and endoscopic approaches have been reported lately for their treatment with favorable results. We present a case of concomitant cholecystoduodenal and cholecystocolic fistula successfully treated with subtotal cholecystectomy and primary closure of the fistulous tracts by laparoscopic approach in a female Hispanic patient.
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Affiliation(s)
- Milton Alberto Muñoz Leija
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | | | - Heliodoro Plata-Álvarez
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | - Victor Daniel Cárdenas-Salas
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
| | - Ramiro Valdez-López
- General Surgery, Hospital General de Zona 6, Instituto Mexicano del Seguro Social, San Nicolas de los Garza, MEX
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20
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Kulkarni DR, Goradia PP, Kulkarni ND, Garge S. Multiple Cholecystoenteric Fistulae With Bouveret Syndrome and Acute Pancreatitis: A Rare Combination. Cureus 2023; 15:e38152. [PMID: 37252554 PMCID: PMC10216002 DOI: 10.7759/cureus.38152] [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: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Multiple cholecystoenteric fistulae, Bouveret syndrome (a form of gallstone ileus), and acute pancreatitis occurring together is very rare. Diagnosis is seldom clinical and is mostly based on computerised tomography (CT) or magnetic resonance imaging (MRI). Endoscopy and minimally invasive surgery have revolutionised the treatment of Bouveret syndrome and cholecystoenteric fistula, respectively, over the last two decades. Laparoscopic repair of cholecystoenteric fistula followed by cholecystectomy is successful on a consistent basis with skilled laparoscopic suturing and advanced laparoscopy. In patients with Bouveret syndrome, when the stone is <4cm and is in the proximal duodenum, it is usually amenable for endoscopic extraction with snares, nets, forceps and lithotripsy. When endoscopy is unavailable or fails, laparoscopic surgery is suitable for these patients. However, stones >4 cm, located in the distal duodenum, multiple fistulae, and associated acute pancreatitis may necessitate open surgery. We present here a case of a 65-year-old Indian female with multiple cholecystoenteric fistulae and Bouveret syndrome with acute pancreatitis with a 6.5 cm gallstone diagnosed on CT scan and MRI and treated successfully by open surgery. We also review the current literature on the management of this complex problem.
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Affiliation(s)
| | - Pooja P Goradia
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
| | - Neha D Kulkarni
- Medicine, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Shrikant Garge
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
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21
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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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22
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Muacevic A, Adler JR, AlOtaibi WS, Alanazi SN, AlKhayyal Y, Mrad B, Abdulla MH, AlHassan N, Bin Traiki T. Hemorrhagic Necrotizing Cholecystitis With Cholecystocolonic Fistula: A Case Report. Cureus 2022; 14:e32187. [PMID: 36620837 PMCID: PMC9810825 DOI: 10.7759/cureus.32187] [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: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cholecystocolonic fistula (CCF) and hemorrhagic cholecystitis are rare complications of gallstones that have a wide range of non-specific symptoms and clinical severity. We present a case of a 74-year-old woman on warfarin who presented to the emergency department with a 10-day history of abdominal pain, vomiting, and watery diarrhea. Her abdomen was distended with generalized tenderness and palpable mass in the right lower quadrant. Laboratory tests revealed leukocytosis and an elevated international normalized ratio (INR). After admission and imaging, exploratory laparotomy showed hemorrhagic cholecystitis with CCF in the cecum. There was no pus or stool contamination. A cholecystectomy followed by right hemicolectomy with primary ileocolic anastomosis was performed. The postoperative course was uneventful, and the patient was discharged in stable condition. The presence of hemorrhagic cholecystitis in conjunction with CCF could lead to significant consequences such as hemorrhagic and septic shock in older patients with comorbidities. It is crucial to identify and intervene early before clinical deterioration.
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23
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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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24
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Liu YY, Bi SY, He QR, Fan Y, Wu SD. Developments in the Diagnosis and Management of Cholecystoenteric Fistula. J INVEST SURG 2022; 35:1841-1846. [PMID: 36167340 DOI: 10.1080/08941939.2022.2113188] [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] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Abstract
Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.
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Affiliation(s)
- Ying-Yu Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shi-Yuan Bi
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Quan-Run He
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuo-Dong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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25
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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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Gadiyaram S, Thota RK. Near-infrared fluorescence guided laparoscopic cholecystectomy in the spectrum of complicated gallstone disease. Medicine (Baltimore) 2022; 101:e31170. [PMID: 36281174 PMCID: PMC9592315 DOI: 10.1097/md.0000000000031170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
ICG fluorescence (ICGF) guidance during laparoscopic cholecystectomy (LC) is gaining wider acceptance. While the accruing data largely addresses ICGF guidance during LC in patients with uncomplicated gallstone disease (UGS) and acute cholecystitis, there is a paucity of data related for complicated gall stone disease (CGS) such as choledocholithiasis, bilio-enteric fistula, remnant gall bladder, etc. The purpose of this study was to evaluate the role of ICGF during LC in the spectrum of CGS with state of the art 4 chip camera system. Retrospective review from a prospectively maintained database of all patients who underwent ICGF guided LC during the period June 1st, 2019 till December 30th, 2021 formed part of the study. Clinical profile and findings on ICGF during LC for CGS were studied. The data was studied to evaluate the potential roles of ICGF during LC for CGS. Of 68 patients, there were 29 males and 39 females. Among them were 32 and 36 in the uncomplicated and complicated gallstone disease groups, respectively. ICGF showed CBD visualization in 67(98.5%) and cystic duct in 62(91%). ICGF guidance helped in management of CGS, prior to, during and after completion of LC. It had novel application in patients undergoing CBD exploration. In our small series of patients with CGS, ICGF guidance enabled a LC and laparoscopic subtotal cholecystectomy in 94% and 6% of patients respectively. The study highlights potential roles and advantages with ICGF guided laparoscopic management for CBD stones, bilioenteric fistula, completion cholecystectomy and cystic duct stones. Large scale multicenter prospective studies are required to clarify the role of ICGF in the wide spectrum of CGS.
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Affiliation(s)
- Srikanth Gadiyaram
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospitals, Jayanagar, Bangalore, India
- *Correspondence: Srikanth Gadiyaram, Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospitals, 27/B, new no 30, 39th cross, Jaya Nagar 8th block, Bangalore-560082, India (e-mail: )
| | - Ravi Kiran Thota
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospitals, Jayanagar, Bangalore, India
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27
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Kobayashi K, Kobara H, Ougi T, Akaiwa Y, Nomura T, Ougi M, Ishikawa K, Ono M, Kamada H, Masaki T. Cholecystocolic fistula closed using endoscopic therapy alone: A case report. Medicine (Baltimore) 2022; 101:e29680. [PMID: 35866795 PMCID: PMC9302365 DOI: 10.1097/md.0000000000029680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cholecystocolic fistula (CCF) is a known but rare complication of cholelithiasis. Treatment for CCF is generally surgical. As the number of elderly patients has increased in recent years, many cases require non-surgical treatment; therefore, endoscopic treatment has gained importance. PATIENT CONCERNS AND DIAGNOSIS An 87-year-old woman presented with impaired consciousness and symptoms of anorexia. Computed tomography showed cholecystitis and a fistula between the gallbladder and transverse colon. Colonoscopy revealed a CCF. The condition was diagnosed as CCF caused by acute cholecystitis. INTERVENTIONS AND OUTCOMES The patient declined surgery due to her age. Endoscopic fistula closure was performed using a through-the-scope clip after endoscopic naso-gallbladder drainage. Successful closure of the fistula resulted in improvement of cholecystitis and anorexia. The patient was discharged after one month. It has been more than 18 months since the procedure, there has been no recurrence. CONCLUSION This report on successful endoscopic closure of a CCF indicates that it may be useful for patients who decline surgery.
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Affiliation(s)
- Kiyoyuki Kobayashi
- Division of Innovative Medicine for Hepatobiliary and Pancreatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
- *Correspondence: Kiyoyuki Kobayashi, MD, PhD, Division of Innovative Medicine for Hepatobiliary and Pancreatology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan (e-mail: )
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
| | - Tomohiro Ougi
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
| | - Yuzuru Akaiwa
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
| | - Takako Nomura
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
| | - Maki Ougi
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
| | - Kayo Ishikawa
- Department of Internal Medicine, HITO Medical Center, Ehime, Japan
| | - Masafumi Ono
- Division of Innovative Medicine for Hepatobiliary and Pancreatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
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28
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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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29
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Krzeczowski RM, Grossman Verner HM, Figueroa B, Burris J. Robotic Diagnosis and Management of Acute Cholecystocolonic Fistula. Cureus 2022; 14:e24101. [PMID: 35573530 PMCID: PMC9106549 DOI: 10.7759/cureus.24101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Cholecystocolonic fistula (CCF) is a rare complication of biliary tract disease. Increased use of imaging has aided in diagnosing these fistulae preoperatively and has established laparoscopy as a safe alternative to laparotomy. Here, we present a 79-year-old male who presented to the emergency room with abdominal pain and was diagnosed with choledocholithiasis. CT scan revealed a CCF, and he underwent endoscopic retrograde cholangiopancreatography (ERCP). He was followed closely to allow maturation of the fistula, and then, da Vinci® Xi robotic cholecystectomy and ligation were performed. Although current comparisons to laparoscopy have yet to demonstrate a clinical advantage, robotic assistance enhances dexterity, visualization, and ergonomics. Our case is one of the first documented successful operative management of CCF using the da Vinci® Xi robot.
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30
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Patidar Y, Chandel K, Chatterjee N, Tripathy TP, Kumar S. Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula—Endovascular Management and Review of Literature. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1745919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractA rare complication of acute cholecystitis is a pseudoaneurysm of the cystic artery. We discuss a case of a 65-year-old man with synchronous cholecystoenteric fistula and cystic artery pseudoaneurysm managed by selective angioembolization of the cystic artery, followed by interval cholecystectomy.
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Navojit Chatterjee
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Tara Prasad Tripathy
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Senthil Kumar
- Department of HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
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31
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Malik A, Bani Fawwaz BA, Michael M, Akram MO, Khan AH. Endoscopic Retrograde Cholangiopancreatography (ERCP): Used to Diagnose and Treat Cholecystoduodenal Fistula, a Rare Clinical Entity. Cureus 2021; 13:e18962. [PMID: 34815904 PMCID: PMC8606037 DOI: 10.7759/cureus.18962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
Biliary enteric fistula is a rare diagnosis. Common etiologies include chronic cholecystitis with cholelithiasis and peptic ulcer disease. Of these, the number one cause is chronic cholecystitis with cholelithiasis. Adhesion of a chronically inflamed gallbladder to the duodenum followed by erosion of the gallbladder wall by gallstones leads to the establishment of an abnormal communication between the gallbladder and duodenum. This abnormal communication, namely, cholecystoduodenal fistula, has a high mortality rate and therefore must be managed in a timely manner. The case presented in this report is that of a 76-year-old female suffering from chronic cholecystitis and cholelithiasis who was both diagnosed with as well as managed for cholecystoduodenal fistula by the use of endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Atika Malik
- Internal Medicine, Punjab Hospital, Sialkot, PAK
| | | | - Miriam Michael
- Internal Medicine, Howard University, Washington DC, USA
| | | | - Abu H Khan
- Gastroenterology and Hepatology, AdventHealth Orlando, Orlando, USA
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32
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Zheng B, Li C, Wang S. Cholecystogastric fistula presenting as pyloric obstruction: A rare case of Bouveret syndrome. Asian J Surg 2021; 45:635-636. [PMID: 34789430 DOI: 10.1016/j.asjsur.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bingfeng Zheng
- Department of General Surgery, the First People's Hospital of Guangyuan, City Guangyuan, 628000, Sichuan, China.
| | - Chunshan Li
- Department of General Surgery, the First People's Hospital of Guangyuan, City Guangyuan, 628000, Sichuan, China
| | - Shaoyuan Wang
- Department of General Surgery, the First People's Hospital of Guangyuan, City Guangyuan, 628000, Sichuan, China
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33
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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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34
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Rangappa MK, Bharathy KGS, Tandon AS, Sikora SS. Simultaneous Cholecysto-duodenal and Cholecysto-colonic Fistulae: an Unusual Complication of Gallstone Disease. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Pararas N, Alkadrou AM, Sayed RL, Pikoulis A, Pikoulis E. An Unusual Case of Mirizzi Syndrome With Double Spontaneous Gallbladder Fistulas With the Colon and the Duodenum Presenting As Acute Cholecystitis. Cureus 2021; 13:e15978. [PMID: 34221780 PMCID: PMC8238018 DOI: 10.7759/cureus.15978] [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] [Indexed: 11/05/2022] Open
Abstract
The Mirizzi syndrome is amongst the rarest complications of long-standing gallstone disease. It is an even rarer occurrence when concurrent with a cholecystoenteric or cholecystoduodenal fistula and might not include an accompanying gallstone ileus. Chronic cholecystitis is the primary etiology, but pre-operative diagnosis is challenging due to its non-specific symptoms compared with acute cholecystitis. In this unusual case, the patient has a Csendes type Va Mirizzi syndrome associated with a double cholecystoduodenal and cholecystocolonic fistula, a rare presentation.
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Affiliation(s)
- Nikolaos Pararas
- Surgery, Dr. Sulaiman Al-Habib Medical Group/Alfaisal University, Riyadh, SAU
| | | | - Rahil L Sayed
- Radiology, Dr. Sulaiman Al Habib Medical Group/Alfaisal University, Riyadh, SAU
| | - Andreas Pikoulis
- Third Department of Surgery, Attikon University Hospital, National & Kapodistrian University of Athens Medical School, Chaidari-Athens, GRC
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National & Kapodistrian University of Athens Medical School, Chaidari-Athens, GRC
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36
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Sato S, Chinda D, Tanaka Y, Kaizuka N, Higuchi N, Ota S, Miyazawa K, Kikuchi H, Aizawa S, Iwamura H, Fukuda S. Effective Endoscopic Closure of Cholecysto-duodenal and Transverse Colon Fistulas Due to Squamous Cell Carcinoma of the Gallbladder Using Polyglycolic Acid Sheets and a Covered Metal Stent. Intern Med 2021; 60:1723-1729. [PMID: 33390496 PMCID: PMC8222133 DOI: 10.2169/internalmedicine.6384-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
An 81-year-old woman presented with abdominal distension and right hypochondrial pain. Abdominal contrast computed tomography and magnetic resonance imaging revealed an 11-cm gallbladder tumor. The patient was diagnosed with squamous cell carcinoma of the gallbladder by endoscopic ultrasound-guided fine-needle aspiration from the gastric antrum. Thereafter, the gallbladder tumor enlarged, and cholecysto-duodenal and transverse colon fistulas were formed. A covered metal stent was placed on the transverse colon, and polyglycolic acid sheets were injected into the duodenum to close the fistulas endoscopically. Endoscopic closure is less invasive than surgery and considered effective for patients with poor general health conditions.
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Affiliation(s)
- Satoshi Sato
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Daisuke Chinda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
- Department of Community Medicine, Hirosaki University Graduate School of Medicine, Japan
| | - Yusuke Tanaka
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Naotoshi Kaizuka
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Naoki Higuchi
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Shinji Ota
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Kuniaki Miyazawa
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Syu Aizawa
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
| | - Hideki Iwamura
- Department of Gastroenterology, Hematology and Rheumatology, Tsugaru General Hospital, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
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37
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Senra F, Acosta A, Doran S, Isla A. Laparoscopic management of cholecystocolic fistula in a patient with a Roux en Y gastric bypass presenting with scurvy-like symptoms: A challenging scenario. Cir Esp 2021; 99:471-473. [PMID: 34130820 DOI: 10.1016/j.cireng.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Fátima Senra
- General Surgery Department, St Mark's Hospital and Academic Institute, London, United Kingdom.
| | - Asunción Acosta
- General Surgery Department, St Mark's Hospital and Academic Institute, London, United Kingdom
| | - Sophie Doran
- General Surgery Department, St Mark's Hospital and Academic Institute, London, United Kingdom
| | - Alberto Isla
- General Surgery Department, St Mark's Hospital and Academic Institute, London, United Kingdom
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38
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Nayak SK, Parthasarathi R, Gupta GHVR, Palanivelu C. Laparoscopic approach in cholecystogastric fistula with cholecystectomy and omental patching: A case report and review. J Minim Access Surg 2021; 17:245-248. [PMID: 32964876 PMCID: PMC8083744 DOI: 10.4103/jmas.jmas_87_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cholecystoenteric fistulas are rare complications of cholelithiasis, with cholecystogastric fistulas (CGFs) being the rarest. Recommended treatment is surgery; however, select asymptomatic patients can be managed conservatively. The population frequently involved is old age with multiple comorbidities. Open surgery comes with its added morbidities, especially in this subgroup and hence laparoscopic surgery might be beneficial. Sometimes, these fistulas can be incomplete. Here, we describe a case of incomplete CGF managed by laparoscopic cholecystectomy and omental patching along with a brief review of the literature.
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Affiliation(s)
| | - R Parthasarathi
- GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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39
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Gonzalez-Urquijo M, Gil-Galindo G, Rodarte-Shade M. Mirizzi syndrome from type I to Vb: a single center experience. Turk J Surg 2020; 36:399-404. [PMID: 33778400 PMCID: PMC7963310 DOI: 10.47717/turkjsurg.2020.4676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study describes a cohort of patients diagnosed with Mirizzi syndrome from type I to Vb, over a period of four years. It aimed to identify diagnostic and management pitfalls of Mirizzi syndrome, as well as their concomitant cholecystobiliary or cholecystoenteric fistulas. MATERIAL AND METHODS We retrospectively reviewed all electronic medical records of patients who underwent surgery for Mirizzi syndrome at a single institution. RESULTS Twenty-two patients (0.6%) were diagnosed with Mirizzi syndrome. Most of the patients were females (n=19, 86.3%). Mean age was 43.8 years (range: 21-71 years). Ultrasound was performed in all (100%) patients. Six (27.2%) patients had a CT scan and six (27.2%) patients had endoscopic retrograde cholangiopancreatography. Overall preoperative diagnosis was achieved on 36.6% (n=8) of the patients. There were the same total and partial cholecystectomies, accounting for ten (45.5%) cases each, one hepaticojejunostomy with cholecystectomy (4.5%), and one enterolithotomy (4.5%). Laparoscopic cholecystectomy was attempted in 15 (68.1%) patients, with conversion to open surgery in 93.3% (n=14) of the patients. An open approach was made in five (22.7%) cases. Four (18.1%) patients were reported as MS type I, both types II and III each account for 22.7% (n=5) of the cases, there was only one (4.5%) patient with type IV, and seven (31.8%) patients with type V. CONCLUSION There are limited studies of patients with Mirizzi syndrome, including type V classification, and when this syndrome is suspected, a preoperative diagnosis should be made to avoid bile duct injuries or lesions to adjacent organs.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | | | - Mario Rodarte-Shade
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
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40
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Sunakawa T, Ko K, Moriyasu R, Nishida Y, Otagiri N, Tauchi K. Emergency surgery for acute cholecystitis associated with cholecystocolonic fistula caused by gallbladder cancer: a case report. J Surg Case Rep 2020; 2020:rjaa305. [PMID: 32963759 PMCID: PMC7490212 DOI: 10.1093/jscr/rjaa305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/14/2022] Open
Abstract
Preoperative diagnosis of cholecystocolonic fistula (CCF) is difficult and the contribution of gallbladder cancer or colon cancer is unclear when there is associated malignancy. We present a case that was diagnosed with acute cholecystitis associated with CCF by multidetector computed tomography (MDCT) preoperatively and malignant neoplasm during emergency surgery. She was finally diagnosed with gallbladder cancer after the operation and underwent a two-stage surgery for regional lymph node dissection. Gallbladder cancer can be a primary malignant cancer causing CCF, whereas MDCT is useful for preoperative diagnosis of CCF. A treatment plan in consideration of gallbladder cancer is advisable for CCF associated with malignant tumor.
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Affiliation(s)
- Taiki Sunakawa
- Department of Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Kenju Ko
- Department of Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Ryo Moriyasu
- Department of Surgery, Aizawa Hospital, Matsumoto, Japan
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41
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Morare N, Mpuku L, Ally Z. Xanthogranulomatous cholecystitis complicated by a cholecysto-colonic fistula and liver abscesses. J Surg Case Rep 2020; 2020:rjaa176. [PMID: 32760484 PMCID: PMC7394136 DOI: 10.1093/jscr/rjaa176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
A 57-year-old male presented to the emergency department with right upper quadrant pain and constitutional symptoms. Initial investigation revealed biliary sepsis with features of chronic cholecystitis, multiple liver abscesses and a fistulous connection between the gallbladder and colon. He was subsequently diagnosed with a cholecysto-colonic fistula, an unusual complication of biliary pathology, with an incidence of 0.06–0.14% at cholecystectomy. It is the second most common form of cholecystoenteric fistula, the first of which is cholecystoduodenal. A preoperative diagnosis was suggested using computed tomography and sinogram imaging. The associated liver abscesses together with the xanthogranulomatous inflammation found on histopathology, makes the case particularly exceptional.
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Affiliation(s)
- Nolitha Morare
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Lwazi Mpuku
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Zain Ally
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
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Laparoscopic management of cholecystocolic fistula in a patient with a Roux en Y gastric bypass presenting with scurvy-like symptoms: A challenging scenario. Cir Esp 2020. [PMID: 32693920 DOI: 10.1016/j.ciresp.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Laparoscopic and endoscopic cooperative surgery for cholecystogastric fistula: A case report. Int J Surg Case Rep 2020; 71:116-119. [PMID: 32446989 PMCID: PMC7242993 DOI: 10.1016/j.ijscr.2020.04.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022] Open
Abstract
Cholecystogastric fistula (CGF) is rarest form of cholecystoenteric fistula (CEF). Our patient had a CGF close to the pylorus. Laparoscopic and endoscopic cooperative surgery (LECS) was used to treat CGF. Intraoperative endoscopy helped see the margin between fistula suture and pylorus. LECS is a viable option to treat CGF, a rare CEF in biliary tract surgery. Introduction Cholecystoenteric fistula (CEF) is rare in biliary tract surgery, and cholecystogastric fistula (CGF) is the rarest form of CEF. Although open cholecystectomy with the closure of the fistula is the gold standard treatment for nonobstructing biliary-enteric fistulas, the optimal treatment for CGF has not been established. Laparoscopic and endoscopic cooperative surgery (LECS), a minimally invasive surgery for gastric submucosal tumors, reportedly helps achieve favorable postoperative outcomes. This report presents a case wherein CGF was treated with LECS. Case presentation An-84-year-old man with a history of chemotherapy for ileocecal diffuse large B cell lymphoma presented with fever and abdominal pain. He was diagnosed with cholangitis, and endoscopic lithotripsy was performed. Abdominal contrast-enhanced computed tomography revealed gastric wall thickening close to the gallbladder, indicating a malignant lymphoma. Esophagogastroduodenoscopy revealed a concavity on the anterior wall of the antrum of the stomach. Direct endoscopic cholangiography, which was performed by the injection of a contrast medium into the concavity, confirmed the concavity to be a CGF. Cholecystectomy with the closure of the fistula using the LECS was performed to check for suture line leakage and the positional relation of the suture line and the pylorus. The resected specimen showed acute and chronic cholecystitis without malignancy. The patient did not experience postoperative complications in the subsequent 3 months. Discussion Resection and closure of the fistula using LECS were performed successfully. Conclusion LECS can be performed for CGF. LECS enables intraoperative observation of the fistula and suture line, and thus reduces postoperative complications.
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Gonzalez-Urquijo M, Rodarte-Shade M, Lozano-Balderas G, Gil-Galindo G. Cholecystoenteric fistula with and without gallstone ileus: A case series. Hepatobiliary Pancreat Dis Int 2020; 19:36-40. [PMID: 31919039 DOI: 10.1016/j.hbpd.2019.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND A cholecystoenteric fistula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. METHODS From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. RESULTS Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal fistula, four patients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33-86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60-240 min), and the median operative blood loss was 50 mL (range 10-600 mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. CONCLUSIONS There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon's expertise and the patient's condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México.
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México
| | - Gerardo Lozano-Balderas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México
| | - Gerardo Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México
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Singh G, Merali N, Shirol S, Drymousis P, Singh S, Veeramootoo D. A case report and review of the literature of Bouveret syndrome. Ann R Coll Surg Engl 2020; 102:e15-e19. [PMID: 31859521 PMCID: PMC6937608 DOI: 10.1308/rcsann.2019.0161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 01/30/2023] Open
Abstract
Bouveret syndrome is a rare variant of gallstone ileus causing gastric outlet obstruction. It results from the formation of either a cholecystoduodenal or a cholecystogastric fistula and subsequent migration of gallstone into the duodenum or pylorus of stomach, causing obstruction. The first case was reported by Leon Bouveret in 1896. We report a case illustrating the rarity and severity of this condition, together with a review of the literature of the different methods of endoscopic and surgical treatment.
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Affiliation(s)
- G Singh
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
| | - N Merali
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
| | - S Shirol
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
| | - P Drymousis
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
| | - S Singh
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
| | - D Veeramootoo
- Upper Gastrointestinal Surgery, Frimley Park Hospital, Frimley Health NHS Trust, Frimley, Camberley, UK
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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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The natural progression of a fistulizing gallstone resulting in massive gastrointestinal hemorrhage and Bouveret syndrome, a rare case. Clin J Gastroenterol 2019; 13:393-396. [PMID: 31654232 PMCID: PMC7239796 DOI: 10.1007/s12328-019-01054-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/09/2019] [Indexed: 12/05/2022]
Abstract
Gallstones are seen very common, especially in the Western World. While most patients are asymptomatic, gallstones can cause life-threatening complications. Here, we present a rare and nearly fatal complication of gallstones, showing the natural progression of gallstone disease. With two very unusual complications of gallstones which occurred in the same patient. Massive gastrointestinal bleeding, and the Bouveret syndrome.
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48
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Bladder Networking: A Unique Case of Cholecystovesicular Fistula. ACG Case Rep J 2019; 6:1-3. [PMID: 31620501 PMCID: PMC6658029 DOI: 10.14309/crj.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 60-year-old woman with chronic lower abdominal pain and green urine. Further workup revealed a cholecystovesicular fistula (CVF), a newly coined term to indicate a fistula between the gallbladder and the urinary bladder. The CVF was treated surgically. The pathophysiology of CVF is thought to result from gallbladder perforation into the liver. Over time, a tract forms inferiorly until it meets another organ, in this case, the urinary bladder. This later complication of the gallbladder disease joins the broader spectrum of cholecystic fistulas. To our knowledge, a CVF has never been reported in the literature.
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49
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Baratta VM, Kurbatov V, Le Blanc JM, Bowker B, Yavorek G. Robotic cholecystectomy and cholecystoenteric fistula closure in a female with remote cholangitis. J Surg Case Rep 2019; 2019:rjz231. [PMID: 31462982 PMCID: PMC6705446 DOI: 10.1093/jscr/rjz231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022] Open
Abstract
Cholecystocolic fistula (CCF), a connection between the gallbladder and neighboring colon, is a rare entity with little consensus as to the optimal surgical management. Existing case reports have described both open and laparoscopic repairs. We describe the first reported case of a successful robotic repair of a CCF in a 50-year-old woman diagnosed with cholangitis 5 years prior to surgery. The patient had a longitudinal follow-up by a single surgeon, allowing for early diagnosis and repair. This case also includes radiographic imaging over 5 years during the index hospitalization and preoperative workup. This allows for a glimpse into the natural pathogenesis of this disease. After robotic surgery, the patient made a complete recovery with no postoperative complications.
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Affiliation(s)
- Vanessa M Baratta
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Vadim Kurbatov
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Justin M Le Blanc
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Brennan Bowker
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA.,Department of Surgery, Hospital of Saint Raphael, New Haven, CT, USA
| | - George Yavorek
- Yale University School of Medicine, Department of Surgery, New Haven, CT, USA.,Department of Surgery, Hospital of Saint Raphael, New Haven, CT, USA
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50
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Abstract
Cholecystocolonic fistula (CCF) is a rare complication of gallstone disease with a variable clinical presentation. It is difficult to diagnose CCF pre-operatively despite modern diagnostic and imaging modalities as they are often asymptomatic or incidentally discovered, often peri-operatively. However, management of this uncommon yet important finding is not very well described in the literature. The most common fistula is the cholecystoduodenal fistula, followed by the cholecystocolonic fistula; the cholecystogastric fistula is reportedly the least commonly reported. We report our experience with three cases of cholecystocolonic fistula discovered on imaging which were subsequently confirmed through surgery.
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Affiliation(s)
| | - Dawar B Khan
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Rabail Raza
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Wasim A Memon
- Radiology, Aga Khan University Hospital, Karachi, PAK
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