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.
Chronic appendicitis is a rare condition involving appendiceal inflammation as these conditions typically present acutely and are treated with appendectomy. However, in a small minority of patients, appendicitis can have a mild presentation and become recurrent or chronic appendicitis. Due to the acute nature and immediate treatment of patients presenting with typical symptoms of appendicitis, chronic appendicitis has been often overlooked and/or misdiagnosed. We present a case in which a 50-year-old male presented with right lower quadrant (RLQ) pain of one-month duration. Computed tomography (CT) imaging showed evidence of lymph node enlargement near the patient’s appendix, raising suspicion of chronic appendicitis. The patient underwent a successful laparoscopic appendectomy.
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