Kuo K K, Sheen P C, Chang S C, Chen J S, Lee K T, Cham C M
Department of Surgery, Kaohsiung Medical University Hospital, Taiwan, Republic of China.
Kaohsiung J Med Sci. 1999 Nov;15(11):674-8.
Spontaneous multiple cholecystoenteric fistulas are relatively rare complications of chronic cholecystitis. One cholecystoduodenal and two cholecystocolonic fistulas were observed in a 65-year-old woman whose symptoms included fever, chills, jaundice, diarrhea, and prolonged right upper quadrant pain. Pneumobilia, which is a pathognomonic sign of bilioenteric fistula, was also detected by her plain abdomen X-ray on admission. Both types of fistulas were correctly diagnosed preoperatively by barium enema, upper GI series and endoscopic retrograde cholangiopancreaticography. The patient was referred for surgery and fistulas were identified during laparotomy. Cholecystectomy, division of these fistulas, and primary repair of these bowel defects were successfully performed. The postoperative course was unremarkable. We report this unusual case and briefly review the hypothesized pathogenesis, typical symptomatology, radiographic diagnosis, complications and therapeutic modalities of this condition.
自发性多发性胆囊肠瘘是慢性胆囊炎相对罕见的并发症。在一名65岁女性中观察到1例胆囊十二指肠瘘和2例胆囊结肠瘘，其症状包括发热、寒战、黄疸、腹泻以及右上腹长期疼痛。入院时腹部平片检查还发现了气腹，这是胆肠瘘的一个特征性体征。两种类型的瘘均通过钡剂灌肠、上消化道造影和内镜逆行胰胆管造影在术前得到正确诊断。患者被转诊接受手术，术中发现了瘘管。成功实施了胆囊切除术、瘘管分离以及肠道缺损的一期修复。术后病程顺利。我们报告这一罕见病例，并简要回顾该疾病的推测发病机制、典型症状、影像学诊断、并发症及治疗方式。
