Lukas Sprick, MD1, David Lehman, MD1, Martin Moehlen, MD, MPH, FACG2 1Tufts University School of Medicine, Portland, ME; 2Maine Medical Center, Portland, ME
Introduction: A cholecystocolonic fistula (CCF) is an abnormal connection between the gallbladder and the colon. It can develop from chronic cholecystitis, typically from gallstones, leading to fistulous formation. This condition is rare but can result in complications such as bowel obstruction and GI bleed.
Case Description/Methods: An 80-year-old woman presented with diffuse abdominal pain and constipation. CT imaging initially suggested an abdominal mass and large bowel obstruction (LBO), later identified as a CCF with a gallstone lodged in the sigmoid colon. The patient was a poor surgical candidate and endoscopic attempts to remove the stone were unsuccessful. The patient deteriorated rapidly after endoscopy, ultimately passing away despite resuscitative efforts.
Discussion: The case highlights the diagnostic challenges of CCF and the complexities of managing LBO caused by gallstones. The rare occurrence of obstruction in the sigmoid colon has been found in other reported cases, highlighting the need to consider this in patients with sigmoid bowel obstruction. This unfortunate outcome emphasizes the importance of prompt recognition and appropriate management of rare, but potentially life-threatening conditions like CCF.
Figure: 1) Coronal image gives a good view of the diffusely distended and obstructed ascending, transverse, and descending colon consistent with large bowel obstruction. 2) At the level of the gallbladder fundus. The arrow indicates the internal wall of the gallbladder fundus, and its direct communication with the posterior aspect of the ascending colon, also known as a cholecystocolonic fistula. 3) Suspected 3-4 cm large, smooth, hyperpigmented suspected gallstone approximately 25cm from the anal verge 4) Coronal image demonstrates a diffusely distended ascending colon. Within the sigmoid colon is a uniformly hypoattenuating ovalic structure which is isodense to the sludge within the lumen of the gallbladder consistent with a pigment gallstone.
Disclosures:
Lukas Sprick indicated no relevant financial relationships.
David Lehman indicated no relevant financial relationships.
Lukas Sprick, MD1, David Lehman, MD1, Martin Moehlen, MD, MPH, FACG2. P0073 - Between a Stone and a Hard Place: A Case of Cholecystocolonic Fistula and Large Bowel Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
