Laparoscopic management of cholecystocolic fistula

Abstract

IntroductionCholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy.AimTo describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments.TechniqueAfter dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery.ConclusionLaparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy.

Asymptomatic Cholecystocolic Fistula Diagnosed Accurately before Surgery

“…[1][2][3] CCF is due to repeated inflammation and adhesive formation between the gallbladder and the colon. 2,4 The etiology of CCFs is diverse, including malignant tumors, trauma, postoperative complications, diverticular disease, and most frequently, complicated biliary lithiasis. 3,7,8 A sequence of events occurs in acute and chronic inflammation of many different causes, resulting in the inflammation of the adjacent colonic serosal surface and adhesion to the gallbladder.…”

“…3,11,12 Clinical symptoms of CCF include chronic diarrhea, abdominal pain, jaundice, fever, nausea, vomiting, steatorrhea, weight loss, hemorrhagic diathesis, and bowel obstruction. [2][3][4] Various diagnostic methods can be used, such as abdominal ultrasonography, CT, magnetic resonance imaging, ERCP, and barium angiography. 7,8 However, in most cases, preoperative diagnosis is difficult because of nonspecific clinical symptoms, which are found incidentally during laparoscopic surgery and is a major cause of open conversion.…”

“…[1][2][3] Fistula into the duodenum (75%) is the most common, followed by those into the colon (10-20%), stomach, jejunum, and abdominal wall. [2][3][4] Cholecystocolic fistula (CCF) is a rare disease with no specific symptoms. 1 Therefore, CCF is reported as rare as 0.06% to 0.14% during cholecystectomy.…”

“…1 Therefore, CCF is reported as rare as 0.06% to 0.14% during cholecystectomy. 4,5 For this reason, if CCF such as pneumobilia is suspected in a patient with multiple gallbladder stones, a thorough radiological evaluation for definite diagnosis is required before treatment. 5,6 We herein report a case of an incidentally discovered asymptomatic CCF that was preoperatively diagnosed and successfully managed using laparoscopic surgery.…”

A novel surgical approach for treatment of sigmoid gallstone ileus

“…The one-stage procedure is associated with reportedly higher morbidity and mortality, and longer operating times, when compared to simple enterotomy 7–9. Laparoscopic10 and endoscopic11 management of cholecystoenteric fistula have also been described. However, findings from autopsy and at re-operation have demonstrated that cholecystoenteric fistulas can close spontaneously, unless there is persistent cholelithiasis 8 12.…”