This document discusses cholecystoenteric fistula, which is a spontaneous tract between the gallbladder and adjacent structures that can form as a rare complication of gallstone disease. It describes the different types of cholecystoenteric fistulas and their causes. Diagnosis is usually made during surgery, though imaging techniques like ultrasound, CT scans, and X-rays may provide clues. Surgical treatment involves removing the gallbladder and repairing the fistula, either in one or two stages depending on the patient's condition. Laparoscopic and endoscopic approaches are also possible in some cases. The ideal treatment remains controversial, but surgery aims to remove stones and close the abnormal connection between organs.
5. Aetiology
Gall stone disease
Others:
malignancy of the colon, biliary system, and
head of the pancreas
Crohn’s disease of duodenum
Peptic ulceration into GB
Antonacci et; al
Department of General and Emergency Surgery, University of Bologna, S. Orsola-Malpighi Hospital,
Via Massarenti 9, 40138 Bologna, Italy
12. CT findings
Pneumobilia,
Two approximated organs with an edematous wall,
Pericholecystic inflammatory change,
A gall stone in the gastrointestinal tract,
Bowel dilatation, and direct visualization of the fistula
Computed tomography demonstration of cholecystogastric fistula Chung Kuao Chou MD, MPH*
Department of Radiology, Yuan’s General Hospital, No. 162, Cheng-Kung 1st Rd, Kaohsiung, Taiwan,
Republic of China
17. One stage procedure
Enterolithotomy, cholecystectomy and fistula
repair at a single setting
Hemodynamically stable patients
Decreased mortality as compared to two
stage procedure
G. Conzo et al
Gallstone ileus: One-stage surgery in an elderly patient One-stage surgery in gallstone ileus
International Journal of surgery case reports
18. Two stages procedure
Enterolithotomy alone and interval
cholecystectomy plus fistula repair
Indications:
Young patients
Retained gall stones
19. Laparoscopic approach
Laparoscopic surgery was contraindicated
earlier
Conversion of laparotomy : at any stage
during operation.
Frozee RC et al. What are the contraindications for laparoscopic cholecystectomy? Am J Surg
1991;164:491–498.
20. Principle :
Removal of GB and closure of fistula
Laparoscopic cholecystectomy f/b Endo GIA
application or hand sewn closure of fistula
21.
22. Endoscopic management
ERCP stenting and/or sphinterotomy
Edward C Toll ,Michael D Kelly
Successful management of cholecystocolic fistula by endoscopic retrograde
cholangiopancreatography: a report of two cases
23. Conclusion
Cholecystoenteric fistula may occur without
obvious symptoms or signs related to chronic
cholelithiasis and,
In appropriate conditions, may be
demonstrated definitively in a routine, readily
available CT examination.
Treatment is surgical and procedure is
determined by the clinical status of the
patient.