Cholecystocolonic Fistula With Acute Cholangitis: A Case Report

Cholecystocolonic fistula (CCF) is a rare type of cholecystoenteric fistula, which are sometimes diagnosed incidentally in patients undergoing cholecystectomy. They are usually a complication of chronic cholecystitis, often secondary to gallstones, and they are difficult to diagnose due to their rarity and vague clinical presentation. If untreated, they can lead to complications such as acute cholangitis, biliary peritonitis, and biliary cirrhosis. This highlights the importance of early recognition of CCF and timely treatment. While the generally accepted management is surgical, there are no consensus guidelines available. We present a case of a 79-year-old with a CCF, diagnosed preoperatively in the setting of workup for acute cholangitis and choledocholithiasis. She presented with four days of right-sided abdominal pain and one day of vomiting and new jaundice. She was initially hypotensive with elevated inflammatory markers, hyperbilirubinaemia, and deranged liver function tests. Contrast-enhanced CT revealed an 11 mm distal common bile duct calculus with hepatic biliary dilatation, gas in the gallbladder lumen, and a large gallstone in the hepatic flexure, which were suggestive of an underlying CCF. She underwent a laparoscopic converted to open cholecystectomy with transcystic bile duct exploration and choledochotomy, as well as right hemicolectomy due to extensive oedema and inflammation surrounding the CCF. This was later followed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary sphincterotomy. Her CCF and acute cholangitis were thus successfully treated with surgical intervention, and she recovered well. The rare occurrence of CCF highlights the importance of having a high index of clinical suspicion preoperatively as well as maintaining surgical flexibility if it is encountered during an operation. Early recognition and surgical intervention of CCF are important to prevent life-threatening complications.