Cholecystoenteric fistula following cholecystectomy: a rare complication case report

Cholecystoenteric fistula (CEF) is a rare complication of biliary disease, characterized by an abnormal connection between the gallbladder and the gastrointestinal tract. It typically arises in the setting of chronic cholelithiasis or inflammation, resulting in the erosion of the gallbladder wall into adjacent gastrointestinal organs. Although imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography (ERCP) have advanced, preoperative diagnosis remains difficult. Post-cholecystectomy CEF is exceptionally rare, with very few cases reported in literature, making its diagnosis and management a significant challenge.

A 51-year-old male with a history of open cholecystectomy in 2007 presented with intermittent abdominal colic and altered bowel habits. He denied fever, weight loss, or gastrointestinal bleeding. Laboratory workup was unremarkable, and tumor markers were within normal range. Colonoscopy revealed no abnormalities. However, contrast-enhanced CT revealed pneumobilia and a fistulous tract between the gallbladder remnant and transverse colon. These findings raised suspicion for a biliary-enteric fistula. The patient subsequently underwent exploratory laparotomy. Intraoperatively, a cholecystocolonic fistula was identified. A completion cholecystectomy with segmental colectomy was performed. Histopathology confirmed chronic inflammation without malignancy. The patient had an uneventful postoperative recovery and was discharged in stable condition.

This case underscores the importance of considering post-cholecystectomy CEF in patients with altered bowel habits and a prior history of biliary surgery. Although rare, this diagnosis should be suspected in patients presenting with pneumobilia and gastrointestinal symptoms without recent instrumentation. CT imaging remains the cornerstone for preoperative detection. Surgical intervention remains the mainstay of treatment, and complete excision of the fistula tract is essential for both symptom resolution and histopathological assessment. This case underscores the importance of considering post-cholecystectomy CEF in patients with altered bowel habits and a history of biliary surgery. High clinical suspicion and advanced imaging are essential for diagnosis. Surgery remains the definitive treatment.