Presentation
Large bowel obstruction secondary to gallstone impacted in rectosigmoid colon.
Patient Data
CT portal venous phase
enterocutaneous fistula: fistula tract from the second part of the duodenum to the skin anteriorly in the right abdominal wall
duodenocolic fistula: fistula tract from transverse colon (hepatic flexure) to duodenum, continuous with enterocutaneous fistula tract
gallbladder not visible - presumed collapsed
dilatation of large bowel - transverse colon dilated to 79 mm at maximum
calcified foreign body at rectosigmoid junction 28 mm
Case Discussion
Comorbidities precluded cholecystectomy 18 months ago when she presented with acute cholecystitis. Percutaneous cholecystostomy is appropriate for such patients and was undertaken at that time 1.
On this occasion she required surgery for large bowel obstruction. The enterocutaneous fistula has formed along the cholecystostomy track.
Duodeno-colic fistulas are rare and are typically associated with advanced colon cancer 2. Duodenal ulcer is the most common cause of benign duodenocolic fistulas 2.
Enterocutaneous fistulas are iatrogenic in about 80% 3.
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