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Cholecystocolonic Fistula Associated With Advanced Mirizzi Syndrome Causing Chronic Diarrhea: Successful Treatment
Koichiro Miyagawa1, Daiki Uchihara1, Shinji Oe1
1The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan, uoeh-u.ac.jp.
Case Reports in Gastrointestinal Medicine
|July 28, 2026
Summary
Cholecystocolonic fistula (CCF), a rare complication of Mirizzi syndrome (MS), can cause chronic diarrhea. A combined endoscopic and surgical approach effectively managed this complex case, offering a potential treatment strategy.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Cholecystocolonic fistula (CCF) is a rare complication of advanced Mirizzi syndrome (MS).
- CCF often presents with chronic watery diarrhea due to abnormal bile entry into the colon.
- The role of endoscopic treatment in MS with CCF is not well-defined.
Purpose of the Study:
- To present a case of Mirizzi syndrome complicated by cholecystocolonic fistula.
- To evaluate the effectiveness of a combined endoscopic and surgical approach for managing this condition.
Main Methods:
- Diagnosis was established using CT, MRI, and ERCP.
- Initial management involved biliary stenting followed by peroral cholangioscopy-guided electrohydraulic lithotripsy for stone clearance.
- The patient subsequently underwent subtotal cholecystectomy with partial colectomy.
Main Results:
- The patient presented with chronic watery diarrhea.
- Endoscopic treatment with stenting and lithotripsy successfully cleared the biliary stone.
- Histopathology confirmed chronic cholecystitis without malignancy, and the patient had an uneventful postoperative recovery.
Conclusions:
- A stepwise approach combining cholangioscopy-guided lithotripsy with targeted surgery can simplify management.
- This strategy facilitates safe management of advanced Mirizzi syndrome with cholecystocolonic fistula.
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