Cholecystoduodenal fistula

Case contributed by Dr Roberto Rafael Ovalle

Presentation

Patient with history of chronic abdominal pain.

Patient Data

Age: 75
Gender: Female
CT

CT Abdomen

The study shows gallabladder wall thickening with edema and cholelithiasis. There is also choledocholithiasis present with biliary dilatation. Pneumobilia is present. There is evidence of a fistulous communication between the gallbladder and the duodenum.

In the stomach there is the presence of a solid mass, homogeneous low attenuation, with well defined margin, that could correspond to gastric GIST or leiomyoma.

CT

Annotated Image

Fistulous communicationbetween the gallbladder and the duodenum (arrows in annotated image), both of which are filled with air.

Case Discussion

Entericobiliary fistulas represent a complication of cholelithiasis or choledocholithiasis. Cholecystoduodenal fistulas are the most common type, followed by cholecystocolic and choledochoduodenal fistulas.

Distal small bowel obstruction from an impacted ectopic gallstone, called gallstone ileus, is an unusual complication of chronic cholecystitis and affects only a minority of patients with cholecystoduodenal fistulas. Gallstones that result in intestinal obstruction typically exceed 2 cm in diameter.

Pneumobilia suggests the presence of an internal biliary fistula in the absence of prior
sphincterotomy, surgical bypass procedure, recent endoscopic retrograde cholangiopancreatography, or passed common duct stone.

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Case information

rID: 35234
Case created: 28th Mar 2015
Last edited: 26th Sep 2017
Inclusion in quiz mode: Included

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