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Cholecystocolonic fistulae are an unusual but documented complication of biliary tract disease. They are the second most common type of biliary tract fistulae, the first most common type being those involving the duodenum. Aetiology is usually due to chronic cholecystitis. Chronic diarrhoea is a presenting feature in these patients and can be overlooked in the preoperative setting leading to intraoperative unexpected complications.1
An 84-year-old woman presented to the gastrointestinal surgeons with a several month history of change in bowel habit, with persistent yellow loose stool. A barium enema revealed a fistula between the transverse colon and gallbladder (fig 1). This was further delineated by a computed tomography (CT) intravenous cholangiogram. Due to persistently raised liver function tests, an endoscopic retrograde cholangio-pancreatogram (ERCP) and sphincterotomy were also performed with stenting. No malignant masses were detected, and no gallstones were present at the time of imaging. The patient’s symptoms fully resolved following stenting.
The most appropriate imaging modality to characterise these fistulae is debatable. Contrast enhanced CT scans allow identification of aerobilia and pericholecystic changes. However, ERCP has a high success rate in diagnosing choledochoduodenal fistulae.2
Biliary tract fistulae present a difficult challenge, if unexpected, in those patients undergoing cholecystectomy with a consequent increase in morbidity. It is therefore important to obtain appropriate preoperative imaging in those patients with a high clinical suspicion.
Footnotes
Competing interests: none.
Patient consent: Patient/guardian consent was obtained for publication