Spontaneous Cholecystocolic Fistula: Case Report

Abstract

A 50-year-old woman presented to the outdoor patient department of our hospital with chief complaint of right-upper quadrant pain, dyspepsia, nausea especially after meals and on-and-off fever for one year. On examination there was no icterus and mild tenderness was present in right hypochondrium but there was no guarding, rigidity or rebound tenderness. No underlying swelling or lump could be appreciated. Bowel and bladder habits were normal. Patient was admitted and investigated with provisional diagnosis of gallstone disease. All blood investigations are essentially normal except serum alkaline phosphatase which is slightly increased. Abdominal ultrasound revealed multiple echogenic shadowing area in lumen with contracted gallbladder, common bile duct and gallbladder wall appears to be normal [Table/ Fig-1]. A diagnosis of chronic cholecystitis with cholelithiasis was made. Patient was prepared for laparoscopic cholecystectomy. During laparoscopy, it was evident that there were dense adhesions between the gallbladder, transverse colon and the omentum. The callot's triangle was virtually inaccessible. It was therefore decided to convert to an open cholecystectomy and a right subcostal incision was used. Dissection in callot's triangle was extremely difficult. Dense adhesions between gallbladder and omentum were separated. A tubular structure was connected to body of gallbladder and right transverse colon, which was not disturbed. Cystic duct and cystic artery was dissected, tied and cut. Gallbladder was separated from liver without disturbing the tubular structure. Now gallbladder was opened from body and multiple tiny calculi were removed. On removing the gall stones it became evident that there was a fistula between gallbladder and right transverse colon [Table/ Fig-2].A cholecystectomy was performed with excision of the fistula and primary repair of colon. The patient made an uneventful recovery and was discharged on the 8 th postoperative day. Histopathological examination of specimen revealed no evidence of malignancy. The patient was followed-up for a period of two months and no complaints were noted. ABSTRACTCholecystocolic fistula is a rare billiary-enteric fistula with variable clinical presentation. Despite modern diagnostic tool a high degree of suspicion is required to diagnose it preoperatively. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications. We are describing a 50-year-old female patient with the diagnosis of chronic cholecystitis with cholelithiasis, which was investigated with routine lab investigations, and abdominal ultrasonography but none of these gave us any clue to the presence of fistula, were discovered incidentally during an open surgery and were appropriately treated.[ Table/ DiSCuSSiOnBilliary-enteric fistulae have been found in 0.9% patients undergoing biliary tract surgery. Most common site of communication is cholecystoduodenal fistula, followed by cholecystocolic fistula, and least common ...