Cholecystocolonic fistula

Last revised by David Luong on 11 Nov 2021

Cholecystocolonic fistulas are most commonly a rare late complication of gallstone disease, resulting from an abnormal communication between the gallbladder and the colon. It is the second most common cholecystoenteric fistula after cholecystoduodenal fistulas 1

These may be completely asymptomatic 2. Patient presentation is variable and may include abdominal pain, chronic diarrhea, fever, nausea and vomiting, steatorrhea, jaundice, and/or weight loss 1,3.

These fistulas can lead to pneumobilia and liver abscesses. In the case of stone impaction in the colon, it will be may cause a large bowel obstruction.

Causes of cholecystocolonic fistulas include 2,3:

Cholecystocolonic fistulas are rarely diagnosed before surgery 1,3. ERCP is considered the most accurate modality 2,3.

There may be gallbladder wall thickening +/- intraluminal air. Pneumobilia may be present. The gallbladder may be adherent to the right side of the colon with a fistula sometimes visualized. Gallstone(s) may be visible within the fistula or within the colonic lumen.

No consensus exists with regards to optimal treatment. Surgical treatment can vary from minimally invasive procedures to extensive resection.

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