Incidental diagnosis of gallbladder adenocarcinoma within screening program of Colorectal Cancer in Spain

We present the case of an asymptomatic 70-year-old woman who underwent a colonoscopy for CRC screening in which a 13 mm sessile polyp (0-Is, JNET 2B) was identified and removed [1]. Histology revealed a tubular adenoma with high-grade dysplasia and non-assessable margins. A follow-up colonoscopy showed a lesion within the scar, suggestive of recurrence, with an inflammatory histology [2]. A complementary CT scan revealed pneumobilia and thickening of the gallbladder wall, consistent with a cholecystocolonic fistula [3]. Consequently, elective right hemicolectomy and cholecystectomy was performed. Histological analysis revealed an invasive gallbladder carcinoma (GC), which continuously extended to the colonic mucosa (pT3N1M0) [4] [5] [6]. Oncological treatment was completed with a partial hepatectomy (segments IV-V), and hepatic hilum lymphadenectomy, along with adjuvant chemotherapy.

GC is a rare disease with poor prognosis (5-year survival rate<5%). It is often asymptomatic and frequently diagnosed incidentally through imaging tests or surgical specimens. Additionally, cholecystocolonic fistula (CCF) is the second most common type of bilio-enteric fistula (20%). It is usually caused by chronic gallstone disease (90%) but can also occur secondary to biliary tract cancers (4%). Symptoms are often minimal and nonspecific. CCF should be suspected in cases of pneumobilia with adhesion of the gallbladder to gastrointestinal organs on imaging studies. Early diagnosis is crucial for timely management and treatment, which can significantly impact survival and comorbidities.

To our knowledge this is the first case described in which a positive faecal occult blood test allows for the diagnosis of a malignant CCF, mimicking a recurrent colonic polyp [7].

Publication History

Article published online:
27 March 2025

• References

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