Laparoscopic management of cholecystoenteric fistula: A single-center experience

Abstract

AimTo report our experience regarding management of cholecystoenteric fistula (CEF) and identify the most effective diagnostic methods and surgical treatment.MethodsIn total, 10,588 patients underwent laparoscopic cholecystectomy for cholecystolithiasis from January 2000 to December 2014 at the Research Institute of General Surgery, Jinling Hospital (Nanjing, China). Twenty-nine patients were diagnosed with CEF preoperatively or intraoperatively. Data were retrospectively collected on demographics, preoperative diagnostics, intraoperative findings, laparoscopic procedures, complications, and follow-up.ResultsTwenty-nine patients (female/male ratio, 2.2; mean age, 68.7 years) with CEF were evaluated. Twenty-three (79.3%) patients had a cholecystoduodenal fistula (CDF), four (13.8%) had a cholecystocolonic fistula (CCF), one (3.4%) had a cholecystogastric fistula, and one (3.4%) had a CDF combined with a CCF. Only nine (31.0%) patients obtained a preoperative diagnosis. All patients initially underwent laparoscopic treatment, but five (17.2%) underwent conversion to open surgery; three of these five developed postoperative morbidity or mortality, and the other two had an uneventful postoperative course. Among patients managed successfully by laparoscopy, the hospital stay ranged from 3 to 6 days (mean, 4 days). All patients were asymptomatic at a mean follow-up of 13 months (range, 3–21 months).ConclusionUltrasound and computed tomography can provide valuable diagnostic clues for CEF. Laparoscopic management of CEF in experienced hands is safe, feasible, and associated with rapid postoperative recovery.

Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting

“…On another note, laparoscopy has been described repeatedly as safe and efficient in the management of CEF and CCF, even when gallstone ileus is present [ 3 , 5 ]. The benefits of this modality should be weighed against its risks especially that patients with complicated CEFs or CCFs may be too fragile to tolerate a pneumoperitoneum.…”

“…A cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis with associated cholecystitis. Its incidence ranges from 0.5 to 0.9% in surgeries for non-malignant biliary disease [ 1 – 3 ]. It is defined as a connection between the gallbladder and the gastrointestinal tract.…”

“…It is defined as a connection between the gallbladder and the gastrointestinal tract. Cholecystoduodenal fistulas account for ~75% of all CEFs, followed less commonly by cholecystocolonic and cholecystogastric fistulas [ 1 , 3 ].…”

Cholecystoenteric Fistula Masquerading as a Bleeding Sub-epithelial Mass

“…[2][3][4][5] Clinical presentation of such fistulae is variable, occurring predominantly in women around the age of 60 years, and they are often diagnosed intraoperatively during interventions such as cholecystectomy. 4,[6][7][8][9] The putative mechanism involves impaction of a gallstone and its subsequent erosion through the gallbladder and duodenal wall. The most common communication is between the gallbladder and the duodenum, although cholecystocolonic and cholecystogastric fistulae have been reported.…”

“…8 The presence of such fistulae can be associated with gallstone ileus, Bouveret syndrome, Mirizzi syndrome, and intraoperative adverse events. 6,9 There are isolated case reports of presentation with upper GI bleeding, often from a marginal ulcer located at the site of the fistula. 10,11 Because these fistulae are often diagnosed intraoperatively, laparoscopic management of cholecystoenteric fistula is feasible in well-equipped, high-volume centers.…”