Cholelithiasis Presenting With a Rare Fate of Cholecystocolonic Fistula (Ccf)

INTRODUCTION Cholelithiasis is a chronic recurrent hepatobiliary disease and one of the major cause of morbidity and mortality throughout the world. Common complications of cholelithiasis are acute cholecystitis, chronic cholecystitis, cholangitis and acute pancreatitis. On the other hand, rare complications include gallbladder carcinoma, gallstone ileus, cholecystoenteric fistula and gallbladder perforation.CASE REPORT A 80 yr old male with history of right upper quadrant intermittent pain since 2 months with history of recurrent diarrhea. On examination, he was icteric and had mild tenderness in the right hypochondrium on deep palpation. In view of deranged liver function tests and ultrasound suggestive of contracted gall bladder, Cect whole abdomen was done which was suggestive of gall bladder with thickened wall with air specks in gall bladder and linear communication with hepatic flexure of colon. Patient was managed with open cholecystectomy with excision of fistula and primary repair of colon. Intra-operatively dense adhesions were present at calots triangle with thickening of gall bladder wall. Fistulous tract was seen between gall bladder and colon. Post-operative hospital stay of patient was uneventful and biopsy harbored no malignancy. DISCUSSION The cholecystoenteric fistula was first described by Courvoisier in 1890. Cholecystocolonic fistulae typically form between the gallbladder and the hepatic flexure of the colon due to their proximity in relation to each other. The combination of pneumobilia, chronic diarrhea, and vitamin K malabsorption has been proposed as a pathognomonic triad for cholecystocolonic fistula. CCF impairs the enterohepatic circulation, leading to a malabsorption syndrome with loss of water and electrolytes from the large intestine leading to diarrhea and weight loss. Rarely, CCF can lead to stone impaction in the rectosigmoid region and can cause large bowel obstruction. It is treated surgically with fistula resection, cholecystectomy and if necessary, common bile duct exploration. If colonic inflammation is severe or there is concern for malignancy, segmental resection of colon is also performed.CONCLUSION The CCF is rare entity, so a high index of suspicion is required to reach the diagnosis. The Cholecystocolonic fistula should be treated surgically to avoid life threatening complications such as cholangitis.