Cholecystoenteric fistula in a patient with advanced gallbladder cancer: A case report and review of literature

Abstract

Background: Cholecystoenteric fistula (CEF) involves the formation of a spontaneous anomalous tract between the gallbladder and the adjacent gastrointestinal tract. Chronic gallbladder inflammation can lead to tissue necrosis, perforation, and fistulogenesis. The most prevalent cause of CEF is chronic cholelithiasis, which rarely results from malignancy. Because the symptoms and laboratory findings associated with CEF are nonspecific, the condition is often misdiagnosed, presenting a challenge to the surgeon when detected intraoperatively. Therefore, a preoperative diagnosis of CEF is crucial.

Case summary: We present the case of a 57-year-old male with advanced gallbladder cancer (GBC) who arrived at the emergency room with persistent vomiting, abdominal pain, and diarrhea. An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second portion of the duodenum and transverse colon. We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula (CDF) or a cholecystocolonic fistula (CCF). He underwent multiple examinations, including esophagogastroduodenoscopy, an upper gastrointestinal series, colonoscopy, and magnetic resonance cholangiopancreatography; the results of these tests confirmed a diagnosis of synchronous CDF and CCF. The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon. His symptoms improved with supportive treatment while hospitalized. He initiated oral targeted therapy with lenvatinib for further anticancer treatment.

Conclusion: The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.

Keywords: Biliary enteric fistula; Case report; Cholecystocolonic fistula; Cholecystoduodenal fistula; Cholecystoenteric fistula; Gallbladder neoplasms.

Figure 1

Abdominopelvic computed tomography. Coronal contrast-enhanced abdominal computed tomography reveals a contracted gallbladder (white arrowhead) in close contact with the second portion of the duodenum (orange arrowhead), with a compromised fat plane between these two structures (white dotted line). A soft-tissue density (white arrow) connects the contracted gallbladder and transverse colon (asterisk).

Figure 2

Barium upper gastrointestinal series. The examination reveals a contrast-filling sac-like structure in the right lower quadrant of the abdomen (orange arrowhead) connected to the second portion of the duodenum (white arrowhead).