Cholecystoduodenal fistula accounts for 80% of cholecystoenteric fistulas, and for 0. Internal biliary fistula is a rare complication of a common surgical disease, cholelithiasis. The incidence of cholecystoduodenal fistula was similar to that reported in the. Incidence of 35% in patients with cholelithiasis 4. Jul 09, 2019 the fistula usually occurs via the fundus of the gallbladder, as this is the farthest from the cystic artery and most likely to be affected in inflammationcaused ischemia. Gallstone ileus is peculiar because it can take the form of a high intestinal obstruction followed by a low intestinal obstruction as the stone travels down the bowel. We presented a case of a cholecystoduodenal fistula in a patient 4 years. Cholecystoduodenal fistula definition of cholecystoduodenal. A 16 fr foley catheter was placed through the gallbladder, and dye was injected revealing contrast flowing directly into the duodenum, consistent with a cholecystoduodenal fistula of approximately 1 cm diameter, about 4 cm distal to the pylorus figure 4. It should be contemplated in elderly patients that have a contracted gallbladder with numerous adhesions.
Cholecystoduodenal fistula is not the contraindication for. The cholecystocolonic fistula is an uncommon but pertinent complication of gallbladder disease, occurring in 0. Once the gallbladder is free of calculi, it may become a blind sinus tract. Port placement may also have to be altered, depending on adhesions to the. Cureus one hole, two tubes, and a tijuana pathology report. The arrowhead indicates the fistula opening on the gallbladder gb. A second stone was found free in the neck of the gallbladder but there. Observations on management of choledochoduodenal fistula. Succcessful laparoscopic treatment of cholecystoduodenal. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic retrograde. Gallstone disease is a common problem in hepatobiliary system and may rarely present as cholecystoenteric fistula. Bilioenteric fistulas are the abnormal communication between the bile duct system and the gastrointestinal tract that occurs spontaneously and is a rare complication of an untreated gallstone in the majority of cases. Computed tomography ct scan has been useful as a diagnostic modality for demonstration of the. The methods employed in diagnosis and treatment of a rare.
This examination demonstrates a fistulous connection between the duodenal bulb and the bile passages, probably the common duct. There is also choledocholithiasis present with biliary dilatation. Bouverets syndrome, cholecystoduodenal fistula with gastric outlet obstruction secondary to an impacted gallstone, is a rare but serious complication of cholelithiasis. The arrowhead indicates the cholecystogastric fistula opening on the gallbladder, which was previously excised. Laparoscopic surgery has become the standard of care for benign gallbladder disease. Gallstone ileus is peculiar because it can take the form of a high intestinal obstruction followed by a low intestinal obstruction as the stone travels down the. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis. Each patient did well postoperatively and was discharged to home on the second postoperative day in good condition.
To our knowledge, there is only one reported case that refers to coexistence of mirrizi type ii syndrome with a parapapillary choledochoduodenal fistula. Gallstone ileus with cholecystoduodenal fistula gallstone ileus with cholecystoduodenal fistula machi, junji. Laparoscopic cholecystectomy was attempted but abandoned and only a biopsy of the gallbladder was performed with pathologist reporting gallbladder adenocarcinoma. Gallstone ileus with cholecystoduodenal fistula, the. Migration of the stone into the terminal ileum and free fluid in the cavity can be observed. These fistulae were repaired laparoscopically using an endoscopic. We presented a case of a cholecystoduodenal fistula in a patient 4 years postrouxeny gastric bypass. Xanthogranulomatous cholecystitis and cholecystoduodenal. Management of this uncommon but possible finding is still ill defined.
Xanthogranulomatous cholecystitis and cholecystoduodenal fis. The arrow indicates the cholecystoduodenal fistula. Gallstone ileus, clinical presentation, diagnostic and treatment. The cholecystic abscess may initially cause a tender area in the abdominal wall and spontaneously rupture, forming a fistula with drainage onto the skin. Preoperative diagnosis of cholecystoduodenal fistula with. Register for email alerts with links to free fulltext articles. Bowel obstruction is the complication in less than 1% of these patients. The patient presented with biliary colic symptoms after a stone became impacted in the fistula and outflow through the cystic duct was intermittently obstructed by a second stone. Coexisting cholecystogastric and cholecystoduodenal fistula, authorkemal beksac and arman erkan and volkan kaynaroglu, booktitlecase reports in surgery.
He remains well and symptom free 22 mo later, on reduced dosage of ci metidine 400 mg orally at bedtime. Spontaneous cholecystoduodenal fistula is a rare complication of the gallbladder calculosis. We report the case of a 69yearold woman who presented with epigastric pain and vomiting in whom crosssectional imaging revealed a duodenal mass with cholecystoduodenal. Coexisting cholecystogastric and cholecystoduodenal fistula. It is a late complication of gallbladder disease with calculus and is mainly encountered in the elderly and females. Cholecystocolonic fistula ccf results from a communication between the gallbladder and the right side of colon. In addition, lc is not associated with increased mortality or morbidity. Two patients were symptom free until they passed away at 3 and 10 months, and the surviving patient was still free of gallbladder symptoms 22 months after the procedure. Bilioenteric fistula is a very uncommon complication of gallstones. In this report we present a case of incomplete cholecystogastric and cholecystoduodenal fistulae in a single patient missed by ultrasonography and endoscopic. Figure 1 from double incomplete internal biliary fistula.
We report the case of a 69yearold woman who presented with epigastric pain and vomiting in whom crosssectional imaging revealed a duodenal mass with cholecystoduodenal fistula and pneumobilia. The usual cause is an underlying bilioenteric fistula between the gallbladder and duodenum cholecystoduodenal fistula through which the stone migrates into the bowel. Cholecystocolonic fistula ccf is a rare complication of gallstone disease with a variable clinical presentation. Cureus one hole, two tubes, and a tijuana pathology. Help with cpt code for take down of a cholecystocolonic fistula. Mirizzi syndrome type ii with cholecystoduodenal fistula.
Cholecystoduodenal fistula refers to a fistulous connection between the gallbladder and the duodenum. Choleduodenal fistula with gastric outlet obstruction. Pdf malrotationassociated cholecystoduodenal fistula. Cholecystoduodenal fistula in a patient postrouxen. Mirizzi syndrome type ii with associated biliary enteric fistula is even rarer. Clinical presentation can vary but some can present with bouveret syndrome. The study shows gallabladder wall thickening with edema and cholelithiasis.
A cholecystoduodenal fistula is a connection between the gallbladder and the duodenum. Pdf fistula between gall bladder and gastrointestinal tractus occurs. Entericobiliary fistulas represent a complication of cholelithiasis or choledocholithiasis. However, management of this uncommon yet important finding is not very well described in the literature. Cholecystoduodenal fistula with gallstone obstruction of the. Jan 17, 2014 a cholecystoduodenal fistula is a connection between the gallbladder and the duodenum. If sufficient fluid is present in the cholecystoenteric fistula it could also.
Computed tomography findings a a gallstone measuring 0 cm in the terminal ileum arrow, b pneumobilia arrow. This is a unique surgical treatment of a rare problem made even. Feb 07, 2014 a cholecystoduodenal fistula society of american gastrointestinal and endoscopic surgeons sages. Dec 17, 2008 cholecystocolonic fistula ccf is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Laparoscopic hand sewn repair of a cholecystoduodenal. It is a rare complication of gallstones and its diagnosis is difficult due to its nonspecific symptomatology. The fistula usually occurs via the fundus of the gallbladder, as this is the farthest from the cystic artery and most likely to be affected in inflammationcaused ischemia.
Jan 01, 2002 gallstone ileus with cholecystoduodenal fistula gallstone ileus with cholecystoduodenal fistula machi, junji. Approximately 6% are due to perforating peptic ulcers. A case report of cholecystoduodenal fistula mistaken for gallbladder. It is considered the most common type of enterobiliary fistulation. To determine the value of ultrasonography in the diagnosis of cholecystoduodenal fistulas cdfs. Bouveret syndrome, cholecystoduodenal fistula, magnetic resonance. Enterobiliary fistulas are relatively uncommon complications of biliary tract disease. Cholecystocolonic fistula ccf is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Ccf is usually a late sequela of chronic gallstone disease and is the second most common cholecystoenteric fistula after the cholecystoduodenal fistula. Since the late 1980s, laparoscopic cholecystectomy lc has been a widely accepted method for treating gallbladder disease. We treated two middleaged women having acute exacerbations of chronic gallbladder disease with laparoscopic cholecystectomy. We describe the course of an 84yearold lady with acute calculous cholecystitis.
We report a case of a patient who presented with biliary colic while in tijuana, mexico. Case 2 a blyrold man was transferred to the massachu. Succcessful laparoscopic treatment of cholecystoduodenal fistula. A cholecystoduodenal fistula society of american gastrointestinal and endoscopic surgeons sages. Preoperative diagnosis of cholecystoduodenal fistula with duodenal obstruction secondary to an impacted gallstone milton vainder, bernard chapman, jerome l. Cholecystoduodenal fistula information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. While it is possible for the fistula to be between the cap and gall bladder, the absence of gallbladder filling makes this seem unlikely. One hole, two tubes, and a tijuana pathology report. A unique complication of florid xanthogranulomatous cholecystitis with cholecystoduodenal fistula formation is described in a 6 yr old male. The usual cause is an underlying bilioenteric fistula between the gallbladder and duodenum cholecystoduodenal fistula through which the stone migrates into. According to a report published in 1946, they occurred in only 4% of patients undergoing biliary tract surgery. There is evidence of a fistulous communication between the gallbladder and the duodenum, both of which are filled with air. The fistulous tract was taken down with a cholecystectomy and duodenum repaired with a modified graham patch.
Cholecystoduodenal fistula cdf is the most common cholecystenteric fistula. Treatment of cholecystoduodenal fistula in the era of. Gallstone ileus with cholecystoduodenal fistula, the american. It may occur as an uncommon complication of chronic cholecystitis.
Volume 82, issue 4, octoberdecember 2017, pages 287295. The patient, who had a short gut syndrome, had been maintained on lifelong total parenteral nutrition tpn following extensive neonatal ischemic bowel necrosis secondary to gastroschisis. Figure 2 from double incomplete internal biliary fistula. Conservative treatment with intravenous antibiotics was initially successful. Diagnosis and treatment of biliary fistulas in the laparoscopic era. A diagnosis of recurrent cholangitis due to cholelithiasis was made, and radiologic studies revealed a cholecystoduodenal fistula. Laparoscopic hand sewn repair of a cholecystoduodenal fistula. These fistulae were repaired laparoscopically using an endoscopic stapling device without complication. Upon return to the united states, extensive evaluation was undertaken including imaging, biopsy, and ultimately two separate exploratory. Cholecystoduodenal fistula, an infrequent complication of. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7. Cholecystoduodenal fistula with gallstone obstruction of. Help with cpt code for take down of a cholecystocolonic. The widespread use of ultrasonography and the early treatment for patients with gallstone.
It is difficult to diagnose ccf preoperatively despite modern diagnostic and imaging modalities as they are often asymptomatic or incidentally discovered, often perioperatively. The most common type of biliary enteric fistula is cholecystoduodenal fistula 70%. A case report abstract fistula between gall bladder and gastrointestinal tractus occurs anywhere for example stomach, duodenum, and colon. The arrow indicates the fistula opening on the stomach wall. Twentythree patients with calculous cholecystitis were suspected to have cdfs on preoperative ultrasonography. It is important to identify mirrizi syndrome and fistula formation because of serious morbidity. Cholecystoduodenal fistula is not the contraindication for laparoscopic surgery sanjeev kumar sareen director and surgical specialist, sareen hospital, amritsar, punjab, india cholecystoduodenal fistula is the complication of gallstone and it is difficult to diagnose this condition preoperatively, whic h is the reason. Cholecystoduodenal fistula radiology reference article. Jul 01, 2019 the usual cause is an underlying bilioenteric fistula between the gallbladder and duodenum cholecystoduodenal fistula through which the stone migrates into. Computed tomography findings a a gallstone measuring 0 cm in the terminal ileum arrow, b pneumobilia arrow head and cholecystoduodenal fistula arrow. Oct 30, 2010 to determine the value of ultrasonography in the diagnosis of cholecystoduodenal fistulas cdfs.
The incidence of cholecystoduodenal fistula was similar to that reported in the medical literature. Oral gastrointestinal gi ultrasound contrast medium was infused to dynamically observe the presence or absence of a cdf, and the results were compared with the operative findings. Laparoscopic management of cholecystoenteric fistula. For definitive treatment of the underlying gallbladder disease or fistula, either a laparoscopic or an open approach can be considered. Pdf spontaneous cholecystoduodenal fistula spectrum of. Bouveret syndrome is a rare form of gallstone ileus which occurs due to impaction of the stone in the duodenum.
For when it is a barrelgall stones fate through duodenal wall to ulcerate forthwith the. All the patients underwent surgical treatment and the diagnostic and. Results of inflammatory reaction adhesion may be occur and between two organs and gall stones pressure may be contribute this process. Spontaneous biliaryenteric fistula is a rare complication of gallbladder pathology, with over 90% of them secondary to cholelithiasis. The methods employed in diagnosis and treatment of a rare cholecystoduodenal cutaneous fistula p j m h s vol. A biliary fistula which may occur spontaneously or after surgery, is an abnormal communication from the biliary system to an organ, cavity or free surface.
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