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Case Reports
. 2023 Aug 9;16(8):e255951.
doi: 10.1136/bcr-2023-255951.

Laparoscopic management of combined cholecystogastric and cholecystocolonic fistulae

Christina Zhu  1 , Ferris Zeitouni  1 , Justin Vaughan  1   2 , Ariel P Santos  3   2
Affiliations
Case Reports

Laparoscopic management of combined cholecystogastric and cholecystocolonic fistulae

Christina Zhu et al. BMJ Case Rep. .

Abstract

Cholecystogastric and cholecystocolonic fistulae are rare sequelae of longstanding cholelithiasis and can complicate surgical management. Our case involves a male patient in his early 40s with a history of chronic cholelithiasis who presented to the emergency department with severe abdominal pain. Findings on imaging were consistent with acute calculous cholecystitis. During laparoscopic cholecystectomy, the presence of both cholecystogastric and cholecystocolonic fistulae was discovered. Fistula resection with cholecystectomy in a one-step approach using indocyanine green (ICG) angiography was performed. The patient improved and was discharged 3 days later. Laparoscopic management complemented by ICG angiography is a viable surgical approach in patients with cholecystogastric and cholecystocolonic fistulae.

Keywords: General surgery; Pancreas and biliary tract.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Abdominal CT showing (A) dilation of the small bowel, (B) collapsed gallbladder and (C) slight pneumobilia.
Figure 2
Figure 2
Abdominal ultrasound showing (A) increased gallbladder wall thickening (0.32 cm) and (B) increased common bile duct diameter (0.80 cm). CBD, common bile duct; GB, gallbladder.
Figure 3
Figure 3
Magnetic resonance cholangiopancreatography showing contracted gallbladder. CBD, common bile duct.
Figure 4
Figure 4
(A) Intraoperative imaging of the stomach attached to the liver medially with the omentum (white arrow) on top. (B) Intraoperative imaging of the cholecystogastric fistula (yellow arrow) between the stomach and the gallbladder (GB). (C) Line diagram, created by Dr Ariel Santos, illustrating cholecystogastric (purple arrow) and cholecystocolonic (blue arrow) fistulae.
Figure 5
Figure 5
Intraoperative imaging of the cholecystocolonic fistula (arrow) noted after takedown of the cholecystogastric fistula. GB. gallbladder.
See this image and copyright information in PMC

References

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