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.
