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: 75 years
Gender: Female

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 in 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 in the hepatic hilum and near the gallbladder.

Red arrow indicates location of the 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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