Cholecystoduodenal fistula in a patient post-Roux-en-Y gastric bypass

Abstract

We presented a case of a cholecystoduodenal fistula in a patient 4 years post-Roux-en-Y gastric bypass. The patient presented with biliary colic symptoms after a stone became impacted in the fistula and outflow through the cystic duct was intermittently obstructed by a second stone. The fistulous tract was taken down with a cholecystectomy and duodenum repaired with a modified Graham patch.

Figure 1

CT of the abdomen and pelvis with PO and IV contrast. A thin black arrow identifies the cholecystoduodenal fistula.

Figure 2

CT slice of the abdomen with PO and IV contrast. A thin black arrow identifies the fistula. A thick white arrow marks the duodenal stump.

Figure 3

MR cholangiopancreatography image. A thick black arrow marks the fistula, and a thick white arrow marks the duodenal stump. A thin black arrow marks the distal common bile duct.

Figure 4

Intraoperative cholangiogram. A thin arrow with a long tail identifies the contracted gallbladder. The thick black arrow marks the fistulous track with proximal filling defect representing the impacted stone. The thin arrow with a short tail marks the distal common bile duct and the thick white arrow identifies the proximal gastric remnant.