Biliary-colonic fistula through a cystic duct stump

Biliary-colonic fistulas are a known, but unusual, complication of gallstone disease. Fistulas occurring after cholecystectomy between cystic duct stump (CDS) and the colon are extremely rare; only two cases have been previously reported in the literature. We report a third case, and discuss the diagnostic work-up and management of this entity.

Biliary-colonic fistulas usually present with biliary and septic complications. ERCP and barium enema play an important diagnostic role. Treatment is mainly surgical, with division of the fistula and excision of the CDS.

CDS-colonic fistulas should be in the differential diagnosis of any patient presenting with sepsis after cholecystectomy. The fistula usually necessitates surgical division. Long CDS seen with laparoscopic cholecystectomy may lead to increase in the incidence of this entity.