Korean J Gastroenterol.  2013 May;61(5):290-293. 10.4166/kjg.2013.61.5.290.

A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding

• Park MK
• Chung YJ
• Baek IY
• Kim HS
• Bae SS
• Lee SO
• Lee KS
• Kwon JK

• KMID: 1501653
• DOI: http://doi.org/10.4166/kjg.2013.61.5.290

Abstract

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

Keyword

Biliary fistula; Hematemesis; Melena; Cholecystitis

MeSH Terms

Aged
Biliary Fistula/complications/*diagnosis/surgery
Cholecystectomy
Endoscopy, Gastrointestinal
Female
Gastric Fistula/complications/*diagnosis/surgery
Gastrointestinal Hemorrhage/complications/*diagnosis
Humans
Intestinal Fistula/complications/*diagnosis/surgery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Upper gastrointestinal endoscopic findings. (A) Fresh blood from an exposed vessel was observed on the great curvature of the gastric antrum. (B) Follow-up examination showed an abnormal opening at the gastric antrum. Yellowish and bubbly contents were drained through the lesion.

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  Fig. 2. Abdomen simple X-ray. It revealed pneumobilia (arrows) in the common bile duct, suggesting the presence of biliary enteric fistula.

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  Fig. 3. Abdominal dynamic CT scan. It showed swelling and fatty infiltration around the gallbladder with contrast enhancement and adhesion of the gallbladder to the gastric antrum (black arrow). Severe inflammatory changes involving the transverse colon were noted (white arrow).

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  Fig. 4. Histopathologic findings. (A) Macroscopic finding of the surgical specimen showed an orifice of the fistula on the transverse colon. (B) Microscopic finding of the cholecysto-colic fistula showed the formation of necrotic and granulation tissue (H&E, ×20).

Reference

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