Incidental Diagnosis of a Cholecystocolic Fistula During Colonoscopy: A Case Report

Cholecystocolic fistula (CCF) is a rare complication of chronic gallbladder disease. Symptoms may be nonspecific or even absent, which is why traditional diagnosis often relies on imaging studies or intraoperative findings, potentially leading to delayed treatment and increased morbidity [1]. We present an unusual case where CCF was initially diagnosed during colonoscopy, enabling prompt surgical intervention. A 68-year-old male with a recent history of intermittent fever, right hypochondrium pain and anemia (Hb 10.5 g/dl) without any macroscopical bleeding, referred to our Endoscopy Unit to perform a colonoscopy. A previous abdominal ultrasonography revealed cholelithiasis with gallbladder wall thickening. During colonoscopy, in the ascending colon, we identified an abnormal orifice, draining pus and surrounded by fragile and ulcerated mucosa, actively bleeding. A through the scope clip was positioned on the ulcerated part, successfully stopping the bleeding. This endoscopic finding led to the suspicion of CCF, which was confirmed by a contrast-enhanced CT scan, performed on the same day. This early diagnosis allowed early surgical intervention with open cholecystectomy and fistula repair after 72 hours.The patient's postoperative course was uneventful, with complete resolution of symptoms at three-month follow-up. This case highlights the importance of a thorough endoscopic examination and demonstrates how incidental findings can lead to early diagnosis and improve patient outcomes in rare biliary-enteric fistulas.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Correia MF, Amonkar DP, Nayak SV, Menezes JL.. Cholecystocolic fistula: a diagnostic enigma. Saudi J Gastroenterol 2009; 15 (1): 42-44

Publication History

Article published online:
27 March 2025