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Alfonso A, McFarland KN, Savsani K, Lee S, Imai D, Khan A, Sharma A, Saeed M, Kumaran V, Cotterell A, Bruno D, Levy M. Robotic management of primary cholecystoduodenal fistula: A case report and brief literature review. Int J Med Robot 2024; 20:e2629. [PMID: 38643388 DOI: 10.1002/rcs.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Cholecystoduodenal fistula (CDF) arises from persistent biliary tree disorders, causing fusion between the gallbladder and duodenum. Initially, open resection was common until laparoscopic fistula closure gained popularity. However, complexities within the gallbladder fossa yielded inconsistent outcomes. Advanced imaging and robotic surgery now enhance precision and detection. METHOD A 62-year-old woman with chronic cholangitis attributed to cholecystoduodenal fistula underwent successful robotic cholecystectomy and fistula closure. RESULTS Postoperatively, the symptoms subsided with no complications during the robotic procedure. Existing studies report favourable outcomes for robotic cholecystectomy and fistula closure. CONCLUSIONS Our case report showcases a rare instance of successful robotic cholecystectomy with CDF closure. This case, along with a review of previous cases, suggests the potential of robotic surgery as the preferred approach, especially for patients anticipated to face significant laparoscopic morbidity.
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Affiliation(s)
- Anjelica Alfonso
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Kush Savsani
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Seung Lee
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Daisuke Imai
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Aamir Khan
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Amit Sharma
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Muhammad Saeed
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Vinay Kumaran
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Adrian Cotterell
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - David Bruno
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Marlon Levy
- Department of Transplant Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Muacevic A, Adler JR, AlOtaibi WS, Alanazi SN, AlKhayyal Y, Mrad B, Abdulla MH, AlHassan N, Bin Traiki T. Hemorrhagic Necrotizing Cholecystitis With Cholecystocolonic Fistula: A Case Report. Cureus 2022; 14:e32187. [PMID: 36620837 PMCID: PMC9810825 DOI: 10.7759/cureus.32187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cholecystocolonic fistula (CCF) and hemorrhagic cholecystitis are rare complications of gallstones that have a wide range of non-specific symptoms and clinical severity. We present a case of a 74-year-old woman on warfarin who presented to the emergency department with a 10-day history of abdominal pain, vomiting, and watery diarrhea. Her abdomen was distended with generalized tenderness and palpable mass in the right lower quadrant. Laboratory tests revealed leukocytosis and an elevated international normalized ratio (INR). After admission and imaging, exploratory laparotomy showed hemorrhagic cholecystitis with CCF in the cecum. There was no pus or stool contamination. A cholecystectomy followed by right hemicolectomy with primary ileocolic anastomosis was performed. The postoperative course was uneventful, and the patient was discharged in stable condition. The presence of hemorrhagic cholecystitis in conjunction with CCF could lead to significant consequences such as hemorrhagic and septic shock in older patients with comorbidities. It is crucial to identify and intervene early before clinical deterioration.
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Liu YY, Bi SY, He QR, Fan Y, Wu SD. Developments in the Diagnosis and Management of Cholecystoenteric Fistula. J INVEST SURG 2022; 35:1841-1846. [PMID: 36167340 DOI: 10.1080/08941939.2022.2113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.
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Affiliation(s)
- Ying-Yu Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shi-Yuan Bi
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Quan-Run He
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuo-Dong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Huang SF, Han YH, Chen J, Zhang J, Huang H. Surgical Management of Cholecystoenteric Fistula in Patients With and Without Gallstone Ileus: An Experience of 29 Cases. Front Surg 2022; 9:950292. [PMID: 35874133 PMCID: PMC9304664 DOI: 10.3389/fsurg.2022.950292] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/24/2022] [Indexed: 12/17/2022] Open
Abstract
Background Cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis. Here, we report our experience on diagnostic methods and surgical management of CEF patients with and without gallstone ileus (GI). Methods This is a retrospective cases series over an 11-year period (2011–2022). Data analyzed included preoperative characteristics, ultrasound, imaging features, operation findings and postoperative course. Results A total of 29 patients diagnosed with CEF were enrolled, 51.7% (15/29) of whom were female, with a median age of 66 years (range: 35–96 years). With regards to subtype distribution, seventeen patients had cholecystoduodenal fistula (CDF), six had cholecystoconlonic fistula (CCF), three exhibited cholecystogastric fistula (CGF), one CDF combination with CCF and two CDF combination with type I Mirizzi syndrome. Twelve patients presented with gallstone ileus, and received one stage procedure or simple Enterolithotomy. The median operation time and blood loss of 157 min (range: 65–360 min) and 40 ml (range: 10–450 ml), respectively. Surgical complications, evidenced by fistula recurrence, were recorded in three patients (3/22; 13.6%), while four (4/29; 13.8%) and one patient (1/29; 3.4%) presented with wound infection and residual stone in common bile duct, respectively. No deaths were reported in our study. Conclusion CEF is a rare complication of gallstone disease that is occasionally found during operation. To date, no consensus has been reached regarding efficacious treatment therapies for CEF patients. For a CEF patient with GI, one stage procedure should be selected prudently, while simple Enterolithotomy would be a mainstream choice for relieving bowel obstruction.
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Choi C, Osman K, Hartley CP, Maselli DB. Cholecystocolonic fistula as an uncommon cause of diarrhea: a case-report and review of the literature. Clin J Gastroenterol 2021; 14:1147-1151. [PMID: 33837936 DOI: 10.1007/s12328-021-01413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
Bilio-enteric fistulization is the aberrant connection between the biliary and luminal digestive tracts. The cholecystocolonic fistula (CCF) is the second most common bilio-enteric fistula (comprising 20% of cases), after the cholocystoduodenal fistula (comprising 70% of all cases). A CCF may result from malignancy or more benign etiologies, such as gallstones, and is thought to arise from a chronic inflammatory cadence of tissue necrosis, tissue perforation, and fistula creation. The combination of chronic watery diarrhea, vitamin K malabsorption, and radiological evidence of pneumobilia in a patient with history of gallstone disease has been suggested as a pathognomonic triad of CCF. Here, we present a case of a 62-year-old woman exhibiting this triad, who was found to have a CCF as a result of chronic gallstone-related disease. Recognition of this rare etiology of chronic diarrhea can enhance clinicians' diagnostic appraisal and management of this common chief complaint.
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Affiliation(s)
- Chansong Choi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karim Osman
- Department of Internal Medicine, Lahey Health and Medical Center, Burlington, MA, USA
| | | | - Daniel Barry Maselli
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Bonventre G, Di Buono G, Buscemi S, Romano G, Agrusa A. Laparoscopic management of cholecystocolonic fistula: A case report and a brief literature review. Int J Surg Case Rep 2020; 68:218-220. [PMID: 32193139 PMCID: PMC7078439 DOI: 10.1016/j.ijscr.2020.02.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/06/2022] Open
Abstract
Cholecystoenteric fistula is a rare and late complication of cholelithiasis. We report a case of cholecysto-colonic fistula with hepatic flexure management by laparoscopic approach, a 64 years old male patients with fever of an unknown origins for two months and abdominal pain. We performed laparoscopic cholecystectomy and repaired colonic wall with intra-corporeal sutures. The laparoscopic management of cholecystoeneteric fistula is a feasible and safe procedure but the operative strategy should be individualized.
Introduction Cholecystoenteric fistula is a rare and late complication of cholelithiasis. The clinical presentation is mostly chronic and is not distinguishable from the dyspeptic symptoms of non-complicated cholelithiasis. For this reason, the preoperative diagnosis is difficult and uncertain, and it is often made up primarily intraoperatively and incidentally during cholecystectomy. In this article, we report a case of cholecystocolonic fistula management by laparoscopic approach. Presentation of case We studied a 64 years old male patient with fever of an unknown origin for two months and abdominal pain. He underwent a contrast enhanced CT abdominal scan that showed a sclerotic gallbladder with a disorganized fluid collection. The colonoscopy identified a cholecystocolonic fistula with hepatic flexure. A laparoscopic cholecystectomy was performed to repair the colonic wall with intra-corporeal sutures. Discussion Thanks to the advancements in CT scan’s resolution and the application of endoscopic technology such as ERCP or colonscopy, preoperative diagnosis of cholecystoenteric fistula has been greatly improved. In addition, cholecystoenteric fistula has been successfully managed laparoscopically with laparoscopic cholecystectomy and closure of the fistula tract. Conclusion The laparoscopic management of cholecystoeneteric fistula is a feasible and safe procedure but the operative strategy should be individualized on diagnosis, patient characteristics, availability of resources and experience of surgical team.
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Affiliation(s)
- G Bonventre
- Department of Surgical, Oncologic and Stomatological Disciplines (Di.Chir.On.S.), University of Palermo, Italy.
| | - G Di Buono
- Department of Surgical, Oncologic and Stomatological Disciplines (Di.Chir.On.S.), University of Palermo, Italy.
| | - S Buscemi
- Department of Surgical, Oncologic and Stomatological Disciplines (Di.Chir.On.S.), University of Palermo, Italy.
| | - G Romano
- Department of Surgical, Oncologic and Stomatological Disciplines (Di.Chir.On.S.), University of Palermo, Italy.
| | - A Agrusa
- Department of Surgical, Oncologic and Stomatological Disciplines (Di.Chir.On.S.), University of Palermo, Italy.
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