• Biliary fistula
• Cholecystoenteric fistula
• Laparoscopic surgery
• Minimally invasive surgery
• Systematic review

• acute cholangitis
• chronic diarrhoea
• colonoscopy
• gallstone cholecystitis
• laparoscopic cholecystectomy complication

• cholecysto-duodenocolonic fistula
• cholecystoenteric fistula
• cholelithiasis
• internal biliary fistula

• cholecystocolonic fistula
• complications of laparoscopic cholecystectomy
• duodenocolic fistula
• laparoscopic cholecystectomy
• thermal bowel injury

• Biliary enteric fistula
• Case report
• Cholecystocolonic fistula
• Cholecystoduodenal fistula
• Cholecystoenteric fistula
• Gallbladder neoplasms

• Cholelithiasis
• Common bile duct stones
• Endoscopic treatment
• Gallbladder stones
• Intrahepatic stones
• Surgical treatment

• Humans
• Evidence-Based Practice
• Gallstones
• Gastrointestinal Tract
• Sphincterotomy, Endoscopic
• Practice Guidelines as Topic

• Algorithm
• Cholecystocolonic fistula
• Diagnosis
• Gallstone ileus
• Risk factors
• Therapy

• Humans
• Female
• Male
• Aged
• Aged, 80 and over
• Middle Aged
• Gallstones/complications
• Gallstones/diagnosis
• Gallstones/surgery
• Ileus/diagnosis
• Ileus/etiology
• Ileus/surgery
• Sigmoid Diseases/surgery
• Intestinal Obstruction/etiology
• Algorithms

• acute cholecystitis
• case report
• cholecystocolic fistula
• endoscopic closure
• endoscopic naso-gallbladder drainage

• Aged
• Aged, 80 and over
• Anorexia
• Cholecystitis/complications
• Cholelithiasis/surgery
• Colonoscopy/adverse effects
• Female
• Humans
• Intestinal Fistula/diagnosis
• Intestinal Fistula/etiology
• Intestinal Fistula/surgery

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.

Gall stone ileus is one of the rare complications of patients with cholelithiasis and usually affects elderly females. The usual sites for the stone to get impacted are the distal ileum and ileocaecal valve. Computed tomography (CT) remains diagnostic and surgery is the treatment of choice. A 60-year-old diabetic female, who was diagnosed with gall stone-induced pancreatitis one month ago, presented to the surgical emergency department with complaints of right upper abdominal pain with recurrent vomiting and constipation of five days duration. The patient was managed conservatively. A provisional diagnosis of subacute intestinal obstruction was kept and a barium meal follow-through (BMFT) was requested. However, BMFT was inconclusive. After two weeks, she presented again to the emergency department with clinical features of subacute intestinal obstruction. The patient was planned for exploratory laparotomy in view of recurrent episodes of obstruction and the presence of peritonism. Intraoperatively, we encountered a cholecystogastric fistula with a gall stone of size approximately 6.5x4 cm impacted at approximately 60 cm from the ileocaecal junction and dilated proximal small bowel loops. The surgical procedure comprised enterolithotomy and cholecystectomy along with repair of cholecystogastric fistula done. The patient had an uneventful postoperative course. Gall stone ileus is a rare cause of small bowel obstruction. Gall stone ileus presenting with a recent history of pancreatitis further makes the suspicion very unlikely.

• GI bleeding
• endoscopy
• gastroenterology
• pancreas and biliary tract
• ulcer

• Aged
• Biliary Fistula/complications
• Biliary Fistula/diagnostic imaging
• Common Bile Duct Diseases
• Duodenal Diseases/complications
• Duodenal Diseases/diagnostic imaging
• Duodenal Ulcer/complications
• Humans
• Intestinal Fistula/complications
• Intestinal Fistula/diagnostic imaging
• Male

• Imperial College Healthcare NHS Trust

• Bile acids
• Cholecystectomy
• Cholecystitis
• Cholecystocolonic fistula
• Diarrhea

• Diarrhea/etiology
• Female
• Gallstones/complications
• Gallstones/diagnostic imaging
• Humans
• Intestinal Fistula/complications
• Intestinal Fistula/diagnostic imaging
• Middle Aged
• Radiography

Biliary fistulas are most commonly caused by cholelithiasis. Other causes include malignancies and peptic ulcer disease. A biliary fistula caused by a penetrating trauma is a rare entity, and a post-traumatic biliary fistula to the renal collecting system is extremely uncommon. We present an extremely rare case of a post-traumatic nephrobiliary fistula incurred after penetrating trauma that was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), biliary stents, and percutaneous drainage.

• Bile leak
• Biliary fistula
• Kidney trauma
• Nephrobiliary fistula
• Penetrating trauma
• Urinary fistula
• Urine leak
• Urobiliary fistula

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.

• cholecystocolonic fistula
• cholelithiasis
• colon
• ct
• gallbladder
• gallstones
• ileus

Patient: Female, 29

Final Diagnosis: Choledocho-duodenal fistula

Symptoms: Abdominal pain • nausea • vomiting

Medication: —

Clinical Procedure: Gastro-jejunostomy • hepatico-jejunostomy

Specialty: Surgery

An 82-year-old man was referred for endoscopic ultrasound of an ulcerated subepithelial mass in the duodenal sweep. The mass was initially identified during upper endoscopy for coffee-ground emesis. During endoscopic ultrasound, a 21-mm hypoechoic ulcerated subepithelial mass with a duct-like structure was identified. During suction to appose the lesion against the tip of the echoendoscope, the ulceration opened into a fistulous tract with drainage of bile and stones. Subsequent abdominal imaging demonstrated that the mass-like duodenal lesion abutted the gallbladder, which had an air-fluid level. We report a cholecystoenteric fistula masquerading as a subepithelial duodenal mass.

•

Cholecystocolonic fistula is different from cholecystoduodenal fistula in that the gallbladder is communicating with the large bowel lumen which has a very high bacterial load.

Cholecystocolonic fistula is a rare condition and is found in roughly 1 in every 10,000. It represents 6.3% to 26.5% of all cholecystenteric fistulas (Chowbey et al., 2006; Angrisani et al., 2001; Yamashita et al., 1997). Cholecystocolonic fistula is the second most common intestinal fistula after cholecystoduodenal fistula (Costi et al., 2009). Rarity of this condition, atypical presentation, diagnostic and management challenges, makes it a unique surgical entity.

A 77-year old male presented with progressive abdominal distension and diarrhea. After initial evaluation, a cholecystocolonic fistula was suspected. Further diagnostic studies including Hepatobiliary Imino-Diacetic Acid (HIDA) scan and Endoscopic Retrograde Cholangiography (ERC) revealed complete occlusion of the cystic duct that could not be relieved. Shortly after, the patient developed septic shock likely of biliary origin and required an urgent open partial cholecystectomy and segmental resection of the involved colonic segment.

In this particular case, the acute presentation together with the inflammatory features around the gallbladder pointed toward an acute inflammatory process and therefore we have tried to delay any operative intervention to allow the inflammation to subside and avoid operating in an inflamed field. Furthermore, our aim was to relieve any sort of biliary obstruction to allow the fistula −if present- to heal by minimizing bile flow through the fistula. Relieving biliary obstruction was not successful in our patient.

Based on our experience with this particular case, we could safely conclude that an operation for cholecystocolonic fistula presence in the setting of biliary obstruction that failed decompressive attempts should be performed in an urgent fashion to avoid biliary sepsis development.

• Biliary sepsis
• Case report
• Cholecystocolonic fistula
• Cholerheic diarrhea
• ERC

• Cholecystectomy
• cholecystocolic fistula
• cholelithiasis
• chronic cholecystitis

To report our experience regarding management of cholecystoenteric fistula (CEF) and identify the most effective diagnostic methods and surgical treatment.

In total, 10,588 patients underwent laparoscopic cholecystectomy for cholecystolithiasis from January 2000 to December 2014 at the Research Institute of General Surgery, Jinling Hospital (Nanjing, China). Twenty-nine patients were diagnosed with CEF preoperatively or intraoperatively. Data were retrospectively collected on demographics, preoperative diagnostics, intraoperative findings, laparoscopic procedures, complications, and follow-up.

Twenty-nine patients (female/male ratio, 2.2; mean age, 68.7 years) with CEF were evaluated. Twenty-three (79.3%) patients had a cholecystoduodenal fistula (CDF), four (13.8%) had a cholecystocolonic fistula (CCF), one (3.4%) had a cholecystogastric fistula, and one (3.4%) had a CDF combined with a CCF. Only nine (31.0%) patients obtained a preoperative diagnosis. All patients initially underwent laparoscopic treatment, but five (17.2%) underwent conversion to open surgery; three of these five developed postoperative morbidity or mortality, and the other two had an uneventful postoperative course. Among patients managed successfully by laparoscopy, the hospital stay ranged from 3 to 6 days (mean, 4 days). All patients were asymptomatic at a mean follow-up of 13 months (range, 3–21 months).

Ultrasound and computed tomography can provide valuable diagnostic clues for CEF. Laparoscopic management of CEF in experienced hands is safe, feasible, and associated with rapid postoperative recovery.

• Cholecystoenteric fistula; management; diagnosis; laparoscopic

•

A bilioduodenal fistula may rarely occur after duodenal switch. This case report is original and interesting showing a successful conservative management of this rare complication.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an advanced operation for morbid obesity. To our knowledge, no internal Biliodigestive Fistula has yet been reported as specific complication in the field of metabolic and bariatric Biliopancreatic diversion.

In this case report, we detail the case of a 57-year-old man who underwent a Single Anastomosis Duodeno-Ileal Switch (SADI-S) bariatric procedure for morbid obesity.

Upon admission 3 weeks after the SADI-S procedure acute sepsis caused by a delayed choledoco-duodenal Fistula was diagnosed.

A conservative management of this rare complication was successful.

We highlight the differential diagnosis and optional treatment in such a rare complication, and how we succeeded in its conservative management, without any need for endoscopic nor surgical intervention.

A review of the literature on different types of Internal Biliodigestive Fistulae and their appropriate management are reported and briefly discussed.

The aim of this case report is to highlight the existence of such a rare complication, and its successful multidisciplinary conservative medical management.

• Blunt trauma
• conservative management
• pneumobilia

Internal biliary fistula is a rare complication of a common surgical disease, cholelithiasis. It is seen in 0.74% of all biliary tract surgeries and is thought to be a result of repeated inflammatory periods of the gallbladder. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic retrograde cholangiopancreatography and diagnosed intraoperatively. In the literature there is only one report of an incomplete cholecystogastric fistula. To our knowledge this is the first case of double incomplete internal biliary fistulae.

• Gallstones/complications
• Gallstones/diagnosis
• Gallstones/surgery
• Humans
• Ileus/complications
• Ileus/diagnosis
• Ileus/surgery
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Risk Factors

Cholecystocolic fistula secondary to gallbladder carcinoma is extremely rare and has been reported in very few studies. Most cholecystocolic fistulae are late complications of gallstone disease, but can also develop following carcinoma of the gallbladder when the necrotic tumor penetrates into the adjacent colon. Although no currently available imaging technique has shown great accuracy in recognizing cholecystocolic fistula, abdominopelvic computed tomography may show fistulous communication and anatomical details. Herein we report an unusual case of cholecystocolic fistula caused by gallbladder carcinoma, which was preoperatively misdiagnosed as hepatic flexure colon carcinoma.

• Cholecystocolic fistula
• Gallbladder carcinoma
• Misdiagnosed
• Hepatic colon carcinoma
• Abdominopelvic computed tomography

• Adenocarcinoma/complications
• Adenocarcinoma/diagnosis
• Adenocarcinoma/surgery
• Biliary Fistula/diagnosis
• Biliary Fistula/etiology
• Biliary Fistula/surgery
• Biopsy
• Cholecystectomy
• Colectomy
• Colonic Diseases/diagnosis
• Colonic Diseases/etiology
• Colonic Diseases/surgery
• Colonic Neoplasms/diagnosis
• Colonoscopy
• Diagnostic Errors
• Female
• Gallbladder Neoplasms/complications
• Gallbladder Neoplasms/diagnosis
• Gallbladder Neoplasms/surgery
• Humans
• Intestinal Fistula/diagnosis
• Intestinal Fistula/etiology
• Intestinal Fistula/surgery
• Lymph Node Excision
• Middle Aged
• Neoplasm Invasiveness
• Predictive Value of Tests
• Tomography, X-Ray Computed

• Biliary tract surgical procedure
• Cholelithiasis
• Laparoscopic cholecystectomy
• Post-cholecystectomy syndrome

• Adult
• Air
• Biliary Tract/diagnostic imaging
• Female
• Gases
• Humans
• Pancreatic Ducts/diagnostic imaging
• Radiography

Gallstone ileus is an uncommon complication of cholelithiasis, usually associated with an internal biliary fistula. Management of gallstone ileus is surgical with enterolithotomy the procedure of choice, followed by fistula closure either as a one or two stage procedure. In this case a 66 year old female presented with colicky abdominal pain, computed tomography (CT) clearly showing a gallstone ileus and cholecystoduodenal fistula. Despite this the patient refused surgery and went on to have spontaneous resolution of the obstruction and passage of gallstones.

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.

• Ampulla of Vater
• Choledochoduodenal fistula
• Stents

• Adult
• Aged
• Biliary Fistula/diagnosis
• Biliary Fistula/etiology
• Biliary Fistula/surgery
• Cholecystectomy, Laparoscopic
• Colonic Diseases/diagnosis
• Colonic Diseases/etiology
• Colonic Diseases/surgery
• Duodenal Diseases/diagnosis
• Duodenal Diseases/etiology
• Duodenal Diseases/surgery
• Female
• Gallbladder Diseases/diagnosis
• Gallbladder Diseases/etiology
• Gallbladder Diseases/surgery
• Gallstones/complications
• Gallstones/surgery
• Humans
• Intestinal Fistula/diagnosis
• Intestinal Fistula/etiology
• Intestinal Fistula/surgery
• Intraoperative Period
• Male
• Middle Aged
• Retrospective Studies

Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.

• Cholecystocolonic fistula
• Cholecystocolonic fistula
• Bilioenteric fistula
• Pneumobilia

• Aged
• Anastomosis, Surgical/methods
• Biliary Fistula/diagnosis
• Biliary Fistula/surgery
• Cholangiography/methods
• Cholecystectomy/methods
• Colectomy/methods
• Colon/diagnostic imaging
• Colon/surgery
• Colonic Diseases/diagnosis
• Colonic Diseases/surgery
• Contrast Media/administration & dosage
• Gallbladder Diseases/diagnosis
• Gallbladder Diseases/surgery
• Humans
• Intestinal Fistula/diagnosis
• Intestinal Fistula/surgery
• Iodipamide/analogs & derivatives
• Liver/diagnostic imaging
• Male
• Pain/etiology
• Preoperative Care/methods
• Radiographic Image Enhancement/methods
• Radiography, Interventional/methods
• Tomography, X-Ray Computed/methods