Presentation
Chronic abdominal pain.
Patient Data
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, both of which are filled with air.
There is a solid, homogeneous, low attenuating mass with well defined margins in the posterior gastric wall. Differential diagnosis include: gastric GIST or leiomyoma.
Arrows indicate the fistulous communication between the gallbladder and the duodenum (cholecystoduodenal fistula).
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.