Gallbladder-duodenal fistula detected by ultrasound - a case report

Abstract

Gallbladder-duodenal (cholecystoduodenal) fistula is an uncommon bilioenteric fistula between the gallbladder and the duodenum. It usually occurs following a chronic case of cholecystitis upon which the gallbladder adheres to the adjacent duodenum, and a stone penetrates through the wall. The case presented herein is that of a gallbladder-duodenal fistula detected primarily with the use of ultrasound imaging, and subsequently confirmed by computed tomography. The patient is a 54-year-old woman who was admitted with upper abdominal pain. The fistula was caused by chronic cholecystitis, however no gallstones were present in the duodenum. Surgical management was undertaken for the patient, and the recovery was uneventful.

Keywords: cholecystitis; chronic; gallbladder-duodenal fistula; gallstones.

Fig. 1.

US image. Gallbladder with thickened walls (arrow) and duodenum (open arrow) with gas bubbles in and between both structures. Arrowhead – gas bubble moving through fistula. Liv – liver

Fig. 2.

US image. Gallbladder with thickened walls (arrowhead), filled with numerous gallstones (white filled arrow) and bowel gas (open arrow). LIV – liver. The presence of bowel gas was suspected due to its bright reflective surface with long ring-down artifacts and its movement in an antigravitational direction to the most elevated area of the gallbladder. The presence of gallstones was suspected due to its hyperechoic surface with dark acoustic shadowing and its lower position on the gallbladder wall.

Fig. 3.

CT image. Fistula canal (arrowhead). Air bubbles in the gallbladder (black arrow) and in the duodenum (open arrow). Gallbladder with a thickened wall. LIV – liver; DU – duodenum