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Koutlas NJ, Pawa R. Cholecystocolonic fistula following endoscopic ultrasound-guided gallbladder drainage for stump cholecystitis. Clin J Gastroenterol 2023; 16:116-120. [PMID: 36287350 DOI: 10.1007/s12328-022-01726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
Cholecystocolonic fistulas are a rare sequela of gallstone disease. Presenting symptoms are variable but a triad of chronic diarrhea, vitamin K malabsorption, and pneumobilia has been proposed. If untreated, recurrent biliary sepsis can occur with substantial morbidity and mortality. Definitive management is surgical although endoscopic treatment has been described in nonsurgical patients. We present a case of a cholecystocolonic fistula following transgastric endoscopic ultrasound-guided gallbladder drainage with a lumen-apposing metal stent for stump cholecystitis. The patient's presenting symptom was diarrhea. Upper endoscopy and cholecystoscopy 4 weeks following gallbladder drainage revealed a cholecystocolonic fistula. The cholecystogastric tract was closed through the scope clips. The patient had no episodes of cholangitis and had a patent biliary tree with a prior biliary sphincterotomy so clinical observation was chosen. Colonoscopy 1 month later confirmed the closure of the fistula and the patient had a resolution of diarrhea. Our case highlights a novel adverse event of endoscopic ultrasound-guided gallbladder drainage caused by direct pressure of the lumen apposing metal and double pigtail stents on an already inflamed gallbladder wall. Endoscopic therapies that aid in transcapillary biliary drainage are viable alternatives to surgery and can result in fistula closure.
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Affiliation(s)
- Nicholas J Koutlas
- Department of Medicine Section On Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Rishi Pawa
- Department of Medicine Section On Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Fukuda Y, Michiura T, Ito D, Takahashi T, Tokuyama S, Morishita H, Nuta J, Miyazaki Y, Hayashi N, Yamabe K. Indirect cholecystoduodenal fistula via hepatoduodenal ligament secondary to gangrenous cholecystitis: a case report. Surg Case Rep 2022; 8:201. [PMID: 36272011 PMCID: PMC9588128 DOI: 10.1186/s40792-022-01557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cholecystoduodenal fistula is an infrequent complication of gallbladder diseases. In the majority of cases, the fistula is formed by direct communication between the gallbladder and duodenum due to gallstone impaction in the gallbladder neck. We herein report a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis. CASE PRESENTATION An 80-year-old woman suspected of having emphysematous cholecystitis by a previous doctor was referred to our hospital for urgent surgery. The initial diagnosis based on additional examinations was gangrenous cholecystitis penetrating the hepatoduodenal ligament. Since she did not complain of signs of peritonitis and was taking an anticoagulant medicine, we avoided surgery and selected percutaneous gallbladder drainage (PTGBD) instead. Contrast imaging of the PTGBD tube and upper endoscopy identified the indirect cholecystoduodenal fistula via the hepatoduodenal ligament. Despite repeated attempts at endoscopic fistula closure using clips, the fistula did not close successfully. We therefore performed laparoscopic cholecystectomy and fistula closure. The postoperative clinical course was uneventful, and she left the hospital on postoperative day 15. The resected gallbladder contained small black stones, and a histological examination revealed gangrenous cholecystitis with no malignant signatures. CONCLUSION We encountered a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis that was successfully treated by laparoscopic cholecystectomy and fistula closure. It is important to recognize the possible formation of indirect cholecystoduodenal fistula in cases of gangrenous cholecystitis penetrating the hepatoduodenal ligament.
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Affiliation(s)
- Yasunari Fukuda
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Toshiya Michiura
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Daisaku Ito
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Tomohiro Takahashi
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Shinji Tokuyama
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Hiromu Morishita
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Junya Nuta
- grid.415240.60000 0004 1772 6414Department of Gastroenterology, Kinan Hospital, Wakayama, Japan
| | - Yasuaki Miyazaki
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Nobuyasu Hayashi
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
| | - Kazuo Yamabe
- grid.415240.60000 0004 1772 6414Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588 Japan
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