An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

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Ryan McCreery1, Matthew Meigh1

  • 1Orange Regional Medical Center, Department of Emergency Medicine, Middletown, New York.

Clinical Practice and Cases in Emergency Medicine
|August 13, 2019
PubMed

Insights

Cholecystoduodenal fistula (CDF) is a rare gallbladder complication. Prompt diagnosis and non-operative management are possible for this condition, highlighting the importance of a broad differential for abdominal pain.

Area of Science:

  • Gastroenterology
  • Abdominal Surgery
  • Diagnostic Imaging

Background:

  • Cholecystoduodenal fistula (CDF) is an uncommon complication of gallbladder disease.
  • Clinical presentation of CDF is often variable and diagnosis can be challenging due to non-specific symptoms.

Purpose of the Study:

  • To present a case of cholecystoduodenal fistula.
  • To emphasize the importance of a broad differential diagnosis for abdominal pain out of proportion to physical exam.
  • To highlight the utility of a multimodality imaging approach in diagnosing biliary-enteric fistulas.

Main Methods:

  • Case report of a 61-year-old male with atrial fibrillation presenting with severe abdominal pain.
  • Diagnostic workup included a multimodality imaging approach.
  • Management was successfully achieved non-operatively.

Main Results:

  • The patient was diagnosed promptly with cholecystoduodenal fistula.
  • Successful non-operative management was achieved.
  • The case underscores the diagnostic challenges and successful outcomes possible with CDF.

Conclusions:

  • Severe abdominal pain out of proportion to exam warrants a broad differential diagnosis.
  • Biliary-enteric fistulas, including CDF, should be considered in the differential.
  • Multimodality imaging is crucial for accurate diagnosis and guiding management of CDF.

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