Quan M. Nhu, MD, PhD, Douglas Hunt, MD, Rebecca Matro, MD Scripps Clinic, La Jolla, CA
Introduction: Cholecystocolonic fistula is an aberrant communication between the gallbladder and the colon that can form secondary to chronic gallstone disease and chronic cholecystitis. We encountered a rare case of cholecystocolonic fistula exacerbating diarrhea in an elderly patient with ulcerative colitis (UC).
Case Description/Methods: The patient is a 79-year-old obese male with multiple metabolic syndrome co-morbidities, remote sigmoid diverticulitis status post sigmoid resection, a history of cholelithiasis complicated by acute cholecystitis status post cholecystostomy with subsequent drain removal but was lost to follow up, recurrent Clostridioides difficile colitis, and recent elderly-onset UC controlled with vedolizumab infusions. He was admitted for sepsis with fevers, chills, nausea, vomiting, and increased non-bloody diarrhea up to 15 times per day over a baseline of 3 times daily, but without abdominal pain. Abdominopelvic CT imaging did not show colitis but revealed a contracted gallbladder, choledocholithiasis and a dilated 16-mm common bile duct. Fecal calprotectin was mildly elevated at 326 µg/g but was lower than a recent high of 1,165 µg/g six months prior. C-reactive protein was elevated at 183.7 mg/L. Stool infectious studies were negative. Blood cultures grew Escherichia coli. Patient was treated with antibiotics for ascending cholangitis and underwent successful ERCP for biliary decompression with plastic biliary stent deployment. During the same hospitalization, patient underwent laparoscopic cholecystectomy uneventfully that incidentally revealed a dense fibrous cholecystocolonic fistula tract between the gallbladder and the transverse colon. Patient’s diarrhea resolved the next day following laparoscopic closure of the cholecystocolonic fistula. At six-month follow up, he remains in clinical remission on vedolizumab maintenance with formed stools.
Discussion: Cholecystocolonic fistula is a rare condition that can occur following chronic inflammation of the gallbladder from chronic cholecystitis. The fistula results in aberrant colonic bile acid exposure, leading to fat malabsorption and chronic bile acid diarrhea. Cholecystocolonic fistula is the second most common cholecystoenteric fistula that is often discovered intraoperatively. The treatment for symptomatic cholecystocolonic fistula is surgery. Our case highlights a rare complication of chronic cholecystitis resulting in cholecystocolonic fistula causing chronic bile acid diarrhea in a patient with ulcerative colitis.
Disclosures: Quan Nhu indicated no relevant financial relationships. Douglas Hunt indicated no relevant financial relationships. Rebecca Matro indicated no relevant financial relationships.
Quan M. Nhu, MD, PhD, Douglas Hunt, MD, Rebecca Matro, MD. P2170 - Cholecystocolonic Fistula Exacerbating Diarrhea in a Patient With Ulcerative Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
