Acute cholecystitis with Cholecystocolic fistula: a case report and pertinent literature review

Abstract

Cholecystocolic fistula (CCF) is a rare late complication of gallstones. The clinical features of CCF are nonspecific and variable. No single test is sufficient to diagnose CCF because of the low sensitivity of the tests or the invasive nature of the procedures, and these tests are not routinely requested for asymptomatic patients. Because CCF is rarely diagnosed preoperatively, patient history, laboratory, and radiological data play an important role in alerting surgeons to the possible existence of a CCF. Treatment involves closing the fistula and performing an open or laparoscopic cholecystectomy.

Hemorrhagic Necrotizing Cholecystitis With Cholecystocolonic Fistula: A Case Report

“…The preoperative diagnosis of CCF is rare, accounting for only 7.9% of all CCF patients, compared to 43% of the series reporting cholecystoenteric fistulas in general [ 6 , 19 , 20 ]. Most CCFs are discovered intraoperatively as incidental findings during cholecystectomies.…”

“…Available abdominal radiography, abdominal ultrasonography, barium studies, biliary scintigraphy, and endoscopic retrograde cholangiopancreatography (ERCP) techniques have been used in cases of CCF [ 5 , 6 , 22 ]. In a recent case report, multidetector CT (MDCT) with intravenous contrast revealed a fistula with a diameter of 2 cm between the gallbladder and transverse colon [ 5 ].…”

“…In a recent case report, multidetector CT (MDCT) with intravenous contrast revealed a fistula with a diameter of 2 cm between the gallbladder and transverse colon [ 5 ]. Failure to identify CCF during surgery can lead to serious complications such as perforation of the colon, which can result in fecal peritonitis, sepsis, and even death in severe cases [ 6 ]. CCF can allow large stones to pass and cause bowel obstruction at the rectosigmoid diverticula, especially if the stone size is more than 2.5 cm [ 6 , 23 ].…”

“…The first theory is that acute calculus cholecystitis leads to inflammation and adhesion of the gallbladder wall to the serosal surface of the adjacent structures, resulting in ischemia that eventually becomes gangrenous. Subsequently, the gallbladder contents penetrate the gangrenous wall due to the increased pressure on the gallbladder [ 4 , 6 ]. The other theory explains CCF by pressure necrosis caused by a gallstone impaction [ 6 ].…”

“…Subsequently, the gallbladder contents penetrate the gangrenous wall due to the increased pressure on the gallbladder [ 4 , 6 ]. The other theory explains CCF by pressure necrosis caused by a gallstone impaction [ 6 ]. Patients usually present with nonspecific symptoms, where diarrhea is the most prominent presentation and is related to the excessive presence of bile acid in the colon [ 3 , 7 ].…”