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Ahmed Tawfik
Beaumont Hospital, Ireland
Posters & Accepted Abstracts: J Hepato Gastroenterol
Cholecystocolic fistula is a rare biliary-enteric fistula, commonly develops as a complication of gall stones, iatrogenic causes or due to the presence of a tumor. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10–20%), and the least common is the cholecystogastric fistula1. Case Summary: An 83-year-old male, a retired construction worker, was referred with nausea, vomiting, and crampy abdominal pain for four days, associated with mild dysphagia. Back-ground history of chronic gallstone cholecystitis (Patient refused cholecystectomy), Felty syndrome, Barrett’s Oesophagus, and hypothyroidism. US Abdomen reported an uncomplicated cholelithiasis with otherwise normal abdominal sonographic appearances. However, CT TAP was significant for a severely distended stomach with pneumobilia and a probable cholecystoduodenal fistula. A NG-tube was inserted to help decompress the stomach and an urgent OGD showed a cholecystoduodenal fistula with a prominent polypoid area in the duodenal bulb, draining bile and normal D2. A large, non-obstructive brownish gallstone (4 cm in size) was noted in the upper gastric body and an unsuccessful attempt to remove the stone was made (traumatic lower oesophagus tears). Polypoid area biopsy results concluded severe duodenitis, no dysplasia. Discussion: Biliary-enteric fistulae patients may present with either Bouveret syndrome (a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum ) or a gallstone ileus2.3. Mortality rate is ranging between 12-33%. Laparoscopic cholecystectomy is treatment of choice for Cholecystocolic fistula4. Endoscopy for stone removal is the preferable choice and can be performed with mechanical, electro-hydraulic, or laser lithotripsy. Our case was subsequently referred to hepatobiliary surgeon.
MBBcH was awarded by the University of Tripoli. Master's degree of research in gastroenterology awarded from the University of Liverpool Ph.D. in gastroenterology awarded from University of Liverpool, MRCPI, and MRCP UK.
