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.

1. CHOLECYSTO
ENTERIC
FISTULA
Dr. Rabindra Tamang
Junior Resident
BPKIHS, Dharan
Nepal

2. Contents
 Introduction
 Clinical features
 Diagnosis
 Treatment
 Conclusion

3. Cholecystoenteric fistula
 Spontaneous tract with bile flow between gall
bladder and adjacent structures
 Rare complication
 Late sequelae

4. Types
 Cholecysto dudenal fistula
 Cholecystocolic fistula
 Cholecystogastric fistula

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

6. Mechanisms
 Inflammatory mechanism
 Pressure necrosis mechanism

7. Clinical presentations
 Symptoms of uncomplicated gall stone
disease
 Jaundice
 Cholangitis
 Gall stone ileus
 Bouveret’s syndrome

9. Diagnosis
 Almost always an intra operative findings
 High degree of suspicion

10. Imaging
 Plain x-ray abdomen

11. Ultrasonography
 Pneumobilia
 Thick gall bladder and atrophic cholecystitis
 Cholelithiasis

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

13. Rigler’s triad

14. Intra op findings
 Dense adhesion between inflamed gall
bladder and stomach.

15. Surgery
 Mainstay of treatment
 The ideal surgical treatment is still
controversial

16. Enterolithotomy
 Extraction of stone through an enterotomy
 Hemodynamically unstable
 Significant co-morbidities

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

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.

24. THANK YOU