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Large cholelithiasis with cholecystoduodenal fistula
Akshay Gupta1, Jayme D Lieberman2, Fernando S Isaza2
1Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown 18103 PA, USA.
Insights
Computed tomography (CT) is crucial for diagnosing gallstones and rare biliary enteric fistulas in patients with gastrointestinal bleeding. Early diagnosis in the emergency department guides critical management for complex cases.
Area of Science:
- Gastroenterology
- Radiology
- Emergency Medicine
Background:
- Cholelithiasis (gallstones) is a common condition.
- Rare complications include cholecystoduodenal fistulas and gastrointestinal (GI) hemorrhage.
- Accurate diagnosis is vital for effective patient management, especially in complex cases.
Observation:
- An 87-year-old female presented with hemorrhagic shock, hematemesis, and hematochezia.
- Computed tomography (CT) revealed cholecystitis with a large gallstone and a biliary enteric fistula.
- Blood products were noted within the gallbladder, indicating active bleeding.
Findings:
- CT imaging successfully diagnosed cholelithiasis and a cholecystoduodenal fistula in a patient with GI bleeding.
- The findings underscore the utility of CT in identifying rare but serious complications of gallstones.
- The case demonstrates the diagnostic power of CT in emergency settings for complex gastrointestinal pathologies.
Implications:
- CT imaging is essential for diagnosing cholelithiasis and biliary enteric fistulas in patients presenting with GI bleeding.
- Prompt diagnosis facilitates timely and appropriate management strategies for medically complex patients.
- This case emphasizes the importance of considering rare complications of gallstones in the differential diagnosis of unexplained GI hemorrhage.
Abstract:
Cholelithiasis is a common gastrointestinal pathology that can lead to rare complications including cholecystoduodenal fistulas and GI hemorrhage. Diagnosing cholelithiasis and cholecystoduodenal fistulas in the emergency department (ED) using computed tomography (CT) imaging despite nonspecific and variable symptoms is critical in determining management strategies for medically complex patients. An 87-year-old medically complex female presented to the ED in hemorrhagic shock after several episodes of hematemesis, hematochezia, and other nonspecific gastrointestinal symptoms. A CT of the abdomen/pelvis was performed revealing cholecystitis with a large 6-cm stone; additionally, a biliary enteric fistula was noted with blood products in the gallbladder. This case highlights the importance of CT imaging in the setting of gastrointestinal bleeding with cholelithiasis and biliary enteric fistula diagnosis, and discusses potential management strategies of these diagnoses in medically complex patients.
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