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Gibreel W, Greiten LL, Alsayed A, et al. Management dilemma of cholecysto-colonic fistula: Case report. Int J Surg Case Rep. 2017;42:233-236doi: 10.1016/j.ijscr.2017.12.017.
Gibreel, W., Greiten, L. L., Alsayed, A., & Schiller, H. J. (2018). Management dilemma of cholecysto-colonic fistula: Case report. International journal of surgery case reports, 42233-236. https://doi.org/10.1016/j.ijscr.2017.12.017
Gibreel, Waleed, et al. "Management dilemma of cholecysto-colonic fistula: Case report." International journal of surgery case reports vol. 42 (2018): 233-236. doi: https://doi.org/10.1016/j.ijscr.2017.12.017
Gibreel W, Greiten LL, Alsayed A, Schiller HJ. Management dilemma of cholecysto-colonic fistula: Case report. Int J Surg Case Rep. 2018;42:233-236. doi: 10.1016/j.ijscr.2017.12.017. Epub 2017 Dec 12. PMID: 29291539; PMCID: PMC5752216.
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Int J Surg Case Rep. 2018;42:233-236. doi: 10.1016/j.ijscr.2017.12.017. Epub 2017 Dec 12.

Management dilemma of cholecysto-colonic fistula: Case report.

International journal of surgery case reports

Waleed Gibreel, Lawrence L Greiten, Ahmed Alsayed, Henry J Schiller

Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA. Electronic address: [email protected].
  2. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.

PMID: 29291539 PMCID: PMC5752216 DOI: 10.1016/j.ijscr.2017.12.017

Abstract

INTRODUCTION: 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.

CASE PRESENTATION: 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.

DISCUSSION: 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.

CONCLUSION: 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.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: Biliary sepsis; Case report; Cholecystocolonic fistula; Cholerheic diarrhea; ERC

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