Unexpected finding of cholecystogastric fistula in a patient undergoing laparoscopic cholecystectomy: A case report

Gallbladder stones are a common occurrence, with a prevalence of approximately 10% in the Pakistani population. A rare but potentially fatal complication of gallstones is cholecystogastric fistulas. The underlying mechanism involves chronic inflammation due to cholelithiasis, causing gradual erosion and eventually leading to fistula formation.

We present a rare case of a cholecystogastric fistula in a 40-year-old female patient, successfully managed with an open surgical approach. The patient initially presented with a 6-month history of intermittent epigastric pain, nausea, and vomiting, which worsened over time. Laboratory investigations and abdominal ultrasound confirmed cholelithiasis, and laparoscopic cholecystectomy was planned. However, intraoperative findings revealed a cholecystogastric fistula, a rare complication of chronic gallstone disease. Given the dense adhesions between the gallbladder and the stomach, the procedure was converted to an open surgery. The fistula was divided, and a cholecystectomy was performed, along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch. The patient recovered uneventfully and was discharged on the third postoperative day.

This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis. The report discusses diagnostic challenges, surgical approaches, and a review of the current literature on managing such rare but serious complications of gallstones.