Singh Karamveer, S Kumar Nayana, Lokavarapu Manoj Joshua, Ammapalem Satish, Selvarasu Monisha, Gupta Amit
Department of General Surgery and Division of Organ Transplant, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2025 Mar 28;17(3):e81350. doi: 10.7759/cureus.81350. eCollection 2025 Mar.
Cholecystoenteric fistulas (CEFs) are rare complications of chronic calculous cholecystitis, often diagnosed intraoperatively due to their nonspecific clinical presentation and challenges in preoperative detection. This study analyzes the surgical management and outcomes of CEFs at a tertiary care center.
A retrospective analysis was conducted on all patients who underwent surgery for CEF in the hepatopancreaticobiliary unit of the Department of Surgery at the All India Institute of Medical Sciences, Rishikesh, India, between June and December 2024. Data on preoperative characteristics, biochemical parameters, intraoperative findings, surgical techniques, conversion rates, and postoperative outcomes were collected and analyzed.
Seven patients were included, with a mean age of 55.6 years (range: 49-69 years). Abdominal pain was the most common symptom (seven, 100%), while cholangitis was present in three (42.86%) cases. Gallstones were found in all patients (seven, 100%) and bile duct stones in two (28.57%). Multiple fistulas were observed in four (57.14%) cases, with cholecystocolonic fistulas (CCFs) and cholecystoduodenal fistulas (CDFs) being the most common combinations. Laparoscopic surgery was attempted in four (57.14%) cases but required conversion to open surgery. Bilioenteric anastomosis with Roux-en-Y hepaticojejunostomy was performed in three (42.86%). Postoperative complications included surgical site infections in two (28.57%) of the cases, and one (14.29%) died in the postoperative period. The mean hospital stay was 13.4 ± 3.8 days.
Cholecystoenteric fistula remains a diagnostic and surgical challenge due to its nonspecific presentation and intraoperative detection. While preoperative imaging can aid in diagnosis, most cases are identified intraoperatively, necessitating modifications in the surgical approach. Advances in laparoscopic techniques have reduced conversion rates, but complex cases still require open surgery. Further studies with larger cohorts are needed to refine diagnostic and therapeutic strategies.
胆囊肠道瘘（CEF）是慢性结石性胆囊炎的罕见并发症，由于其临床表现不具特异性且术前检测存在挑战，常于术中确诊。本研究分析了一家三级医疗中心对CEF的手术治疗及结果。
对2024年6月至12月期间在印度瑞诗凯诗全印医学科学研究所外科肝胆胰科接受CEF手术的所有患者进行回顾性分析。收集并分析术前特征、生化参数、术中发现、手术技术、中转率及术后结果等数据。
纳入7例患者，平均年龄55.6岁（范围：49 - 69岁）。腹痛是最常见症状（7例，100%），3例（42.86%）出现胆管炎。所有患者均发现胆结石（7例，100%），2例（28.57%）发现胆管结石。4例（57.14%）观察到多处瘘，胆囊结肠瘘（CCF）和胆囊十二指肠瘘（CDF）是最常见的组合。4例（57.14%）尝试腹腔镜手术，但均需中转开腹手术。3例（42.86%）行Roux-en-Y肝空肠吻合术的胆肠吻合术。术后并发症包括2例（28.57%）手术部位感染，1例（14.29%）术后死亡。平均住院时间为13.4 ± 3.8天。
由于胆囊肠道瘘临床表现不具特异性且需术中检测，其诊断和手术仍具挑战性。虽然术前影像学有助于诊断，但大多数病例在术中确诊，因此需要调整手术方式。腹腔镜技术的进步降低了中转率，但复杂病例仍需开腹手术。需要进一步开展更大样本队列研究以优化诊断和治疗策略。
