Diagnosis and treatment of cholecystogastric fistula: a case report

Internal biliary fistulas are uncommon complications of chronic cholelithiasis, with Cholecystogastric fistula being particularly rare. Due to their non-specific clinical presentation, they are often diagnosed intraoperatively.

A 54-year-old male presented with a 7-day history of intermittent right upper quadrant pain. Preoperative computed tomography (CT) revealed pneumobilia and a suspected communication between the gallbladder and the gastric antrum. Subsequent gastroscopy confirmed the diagnosis, identifying a mucosal depression in the posterior gastric antrum with active bile drainage and an incarcerated gallstone. The patient underwent laparoscopic cholecystectomy, excision of the fistula, and primary repair of the gastric defect. The postoperative course was uneventful, and the patient was discharged 17 days after surgery.

This case underscores the diagnostic value of combining multi-slice CT with endoscopic evaluation for rare internal biliary fistulas. Surgical intervention remains the definitive treatment, and a preoperative diagnosis helps in the surgical planning.