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Cholecystocolonic fistula as an uncommon cause of diarrhea: a case-report and review of the literature

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Abstract

Bilio-enteric fistulization is the aberrant connection between the biliary and luminal digestive tracts. The cholecystocolonic fistula (CCF) is the second most common bilio-enteric fistula (comprising 20% of cases), after the cholocystoduodenal fistula (comprising 70% of all cases). A CCF may result from malignancy or more benign etiologies, such as gallstones, and is thought to arise from a chronic inflammatory cadence of tissue necrosis, tissue perforation, and fistula creation. The combination of chronic watery diarrhea, vitamin K malabsorption, and radiological evidence of pneumobilia in a patient with history of gallstone disease has been suggested as a pathognomonic triad of CCF. Here, we present a case of a 62-year-old woman exhibiting this triad, who was found to have a CCF as a result of chronic gallstone-related disease. Recognition of this rare etiology of chronic diarrhea can enhance clinicians’ diagnostic appraisal and management of this common chief complaint.

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Abbreviations

CCF:

Cholecystocolonic fistula

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

CFTR:

Cystic fibrosis transmembrane conductance regulator

SIBO:

Small intestinal bacterial overgrowth

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Acknowledgements

Special thank you to our patient for giving us the permission to share her story.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Chansong Choi

  2. Department of Internal Medicine, Lahey Health and Medical Center, Burlington, MA, USA

    Karim Osman

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Christopher Pierce Hartley

  4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Daniel Barry Maselli

Authors
  1. Chansong Choi
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  2. Karim Osman
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  3. Christopher Pierce Hartley
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  4. Daniel Barry Maselli
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Correspondence to Daniel Barry Maselli.

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Chansong Choi, Christopher Hartley, Daniel Maselli, and Karim Osman declare that they do not have any conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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Choi, C., Osman, K., Hartley, C.P. et al. Cholecystocolonic fistula as an uncommon cause of diarrhea: a case-report and review of the literature. Clin J Gastroenterol 14, 1147–1151 (2021). https://doi.org/10.1007/s12328-021-01413-7

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  • DOI: https://doi.org/10.1007/s12328-021-01413-7

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