The cholecysto-colic relationships. A roentgen-anatomic study of the colonic manifestations of gallbladder disorders.

In approximately 80 per cent of cases the gallbladder is closely applied to the superior medial aspect of the right colic flexure. This intimate anatomic relationship provides pathways for direct extension of both inflammatory and neoplastic lesions of the gallbladder to involve the adjacent colon. The resultant secondary colonic abnormalities noted in 15 patients have been analyzed and correlated with surgical-pathologic findings. In acute cholecystitis, barium enema examination shows evidence of indentation by an enlarged gallbladder, spasm and mucosal edema in the anterior hepatic flexure. Chronic cholecystitis results in involvement of the adjacent colon by fibrous adhesions and inflammatory reaction. These may further lead to the development of pseudotumors simulating primary carcinoma of the colon. Similar findings including cholecysto-colic fistulae may be the initial manifestations of carcinoma of the gallbladder. The spectrum of pathologic-roentgenographic alterations in the cholecysto-colic interface is described and illustrated. Recognition of these features is of critical importance for the correct interpretation of barium enema findings and the subsequent management of patients with gallbladder disorders.