Cholecystoduodenal fistula

Case contributed by Dr Dario Giambelluca

Presentation

Epigastric pain, nausea and vomiting in a patient with previous diagnosis of cholelithiasis on ultrasound imaging.

Patient Data

Age: 74
Gender: Female
CT

Portal venous phase CT images show a connection between the gallbladder and the proximal duodenum, in the lumen of which there are some ectopic gallstones (maximum diameter of 2 cm); there is also pneumobilia in the left hepatic lobe and gas into the gallbladder lumen.

The gallbladder is contracted and inflamed with thickening and hyperenhancement of the wall.

There are no signs of gastric obstruction (patient with nasogastric tube). Centimetric lymph nodes int the hepatic hilum and near the gallbladder.

Annotated image

Red arrow indicates location of cholecystoduodenal fistula. 

Case Discussion

Cholecystoduodenal fistulas represent a complication of cholelithiasis and is the most common type of enterobiliary fistulation.

CT demonstrates a fistulous tract between the gallbladder and duodenum and some ectopic gallstones. Pneumobilia is a common feature.

This condition can lead to Bouveret syndrome or gallstone ileus.

This patient was subsequently treated with laparoscopic cholecystectomy.

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Case information

rID: 48959
Case created: 2nd Nov 2016
Last edited: 5th Nov 2016
Inclusion in quiz mode: Excluded

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