A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding

Min Kyu Park; Yun Jin Chung; In Yub Baek; Hyeong Seok Kim; Sang Soo Bae; Su Ok Lee; Kyoung Suk Lee; Jong Kyu Kwon

doi:10.4166/kjg.2013.61.5.290

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Park, Chung, Baek, Kim, Bae, Lee, Lee, and Kwon: A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding

Case Report

Korean J Gastroenterol 2013;61(5):290-293.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.5.290

A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding

Min Kyu Park, Yun Jin Chung, In Yub Baek, Hyeong Seok Kim, Sang Soo Bae, Su Ok Lee, Kyoung Suk Lee, Jong Kyu Kwon

Department of Gastrointestinal Medicine, Daegu Fatima Hospital, Daegu, Korea

Correspondence to: Yun Jin Chung, Department of Gastrointestinal Medicine, Daegu Fatima Hospital, 576-31 Shinam-dong, Dong-gu, Daegu 701-600, Korea. Tel: +82-53-940-7191, Fax: +82-53-954-7417, E-mail: gooddr@hotmail.co.kr

Received 2 August 201228 September 2012 Accepted 9 October 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

Keywords: Biliary fistula, Hematemesis, Melena, Cholecystitis

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Fig. 1.

Upper gastrointestinal endoscopic findings. (A) Fresh blood from an exposed vessel was observed on the great curvature of the gastric antrum. (B) Follow-up examination showed an abnormal opening at the gastric antrum. Yellowish and bubbly contents were drained through the lesion.

Fig. 2.

Abdomen simple X-ray. It revealed pneumobilia (arrows) in the common bile duct, suggesting the presence of biliary enteric fistula.

Fig. 3.

Abdominal dynamic CT scan. It showed swelling and fatty infiltration around the gallbladder with contrast enhancement and adhesion of the gallbladder to the gastric antrum (black arrow). Severe inflammatory changes involving the transverse colon were noted (white arrow).

Fig. 4.

Histopathologic findings. (A) Macroscopic finding of the surgical specimen showed an orifice of the fistula on the transverse colon. (B) Microscopic finding of the cholecysto-colic fistula showed the formation of necrotic and granulation tissue (H&E, ×20).

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