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Gallstone ileus, a rare cause of mechanical bowel obstruction, occurs due to the formation of a cholecystenteric fistula allowing gallstones to migrate into the gastrointestinal tract. The condition occurs mostly in elderly patients, particularly women, and carries a significant mortality risk due to delayed diagnosis. This case report discusses a 77-year-old female patient with a history of chronic medical conditions, who self-presented with periumbilical pain, nausea, and reduced bowel movements.

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Gallstone ileus is a rare but potentially life-threatening condition resulting from the migration of gallstones into the gastrointestinal tract, which often necessitates surgical intervention. Three surgical procedures are well known and are practiced in clinical medicine; they include entero-lithotomy alone, entero-lithotomy with cholecystectomy, and enterolithotomy with fistula closure. However, there is no consensus regarding the best surgical approach as far as mortality, morbidity, and operative outcomes are concerned.

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Introduction: Cholecysto-gastric fistula is a rare, life-threatening complication of cholelithiasis that presents significant challenge to surgeons. Early diagnosis can be obtained and surgical intervention can be planned as elective case. Dilemma comes when patient presenting with acute acute abdominal symptoms necessitating immediate surgery, decision-making becomes more complex increasing morbidity and mortality.

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Cholecystocolonic fistula: an incidental intraoperative discovery managed laparoscopically.

BMJ Case Rep

October 2024

General Surgery, Chettinad Academy of Research and Education, Kanchipuram, India

Cholecystoenteric fistula is a rare complication of cholelithiasis, occurring in 3%-5% of patients with cholelithiasis. The symptoms are typically minimal and vague, with either acute or subacute presentations, rarely leading to bowel obstruction, and occasionally manifesting as chronic abdominal pain. In this case, a male patient in his early 30s presented with epigastric and right hypochondrial pain.

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Article Synopsis
  • Cholecystoenteric fistulae are uncommon complications that occur in about 0.5% to 0.9% of patients who undergo cholecystectomy due to gallstone disease.
  • The most frequent type is a cholecystoduodenal fistula, followed by a cholecystocolonic fistula.
  • The paper discusses a unique case involving both fistula types leading to pneumobilia, which was treated through laparoscopic subtotal cholecystectomy and open repair of the fistulae, highlighting the need for careful planning and skilled surgery for such rare cases.
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