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• W2912459143 abstract "Cholecystocolic fistula (CCF) is an uncommon complication of cholecystitis with reported incidence of 0.13%. It is typically managed surgically via fistula resection at the time of cholecystectomy. However, in the presence of severe local inflammation the surgery is more challenging, often times requiring more extensive colonic resection. We report first case of cholecystocolic fistula definitively diagnosed by colonoscopy with successful closure of the fistula using endoscopic clips, allowing for optimized medical therapy prior to cholecystectomy and resection of the fistula. A 34-year-old man presented with symptoms and signs of cholecystitis. An abdominal ultrasound confirmed presence of gall stones. Computed tomography showed marked inflammatory changes of the gall bladder, involving adjacent area of the colon at the hepatic flexure. Air in the gall bladder suggested CCF. Given the concern for complicated cholecystitis, cholecystostomy tube was placed and cholangiogram confirmed the CCF. Subsequently, patient underwent colonoscopy to exclude colonic lesion including malignancy as the etiology. A small mucosal defect was seen at the hepatic flexure, suspicious for fistulous opening. The fistula was confirmed after methylene blue injection via the cholecystostomy tube; the opening was closed with three endoscopic clips. Repeat injection of methylene blue through the tube revealed no evidence of drainage through the defect. Patient was discharged with a 14-day course of antibiotics with the drain in place. A month later, patient underwent elective laparoscopic cholecystectomy and fistula take-down, involving only limited wedge resection of the affected colon. Cholecystoduodenal and CCF are the most common types of bilio-enteric fistulae. The standard treatment of CCF is open or laparoscopic cholecystectomy and closure of the fistula using suture or placing a drain into it or segmental resection of the colon with re-anastomosis. In complicated cholecystitis, surgery may need to be delayed after a period of medical therapy to minimize the extent of resection of the surrounding organs. However, during this period, there is a risk of ascending bacterial translocation through the fistula, leading to recurrent cholangitis subjecting to increased morbidity and mortality. In our case, the fistulous opening was able to be identified and confirmed; it was readily accessible for closure with endoscopic clips.Figure: Colonoscopic view of the cholecystocolic fistula after methylene blue injection through the cholecystostomy catheter.Figure: Successful closure of the colonic opening of the fistula with endoscopic clips.Figure: Fluoroscopic image showing the cholecystocolic fistula." @default.
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• W2912459143 date "2017-10-01" @default.
• W2912459143 modified "2023-09-27" @default.
• W2912459143 title "Endoscopic Closure of Cholecystocolic Fistula: Case Report and Review of the Literature" @default.
• W2912459143 doi "https://doi.org/10.14309/00000434-201710001-01825" @default.
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