Mushtaq Muhammad, Khan Ayesha, Tran Minh, Walker John, Parupudi Sreeram
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX.
ACG Case Rep J. 2024 Sep 27;11(10):e01525. doi: 10.14309/crj.0000000000001525. eCollection 2024 Oct.
Biliary enteric fistulas are rare form of internal biliary fistula encountered in <1% of patients with biliary disease while cholecystocolic fistulas are even rarer with reported incidence of 0.06%-0.14% in patients undergoing cholecystectomy. We present a case of biliary colonic fistula that developed in the context of obstructive cholelithiasis, emphasizing a pathological process involving chronic inflammation due to gallstone with a gradual erosion into the surrounding structure. A high index of suspicion is required for diagnosis, given the presentation with nonspecific symptoms. Given the risk of imminent cholangitis, sepsis, and liver parenchymal damage, early treatment with cholecystectomy with the closure of the fistula is recommended.
胆肠瘘是一种罕见的内瘘形式，在胆道疾病患者中发生率低于1%，而胆囊结肠瘘更为罕见，据报道在接受胆囊切除术的患者中发生率为0.06%-0.14%。我们报告一例在梗阻性胆石症背景下发生的胆囊结肠瘘病例，强调了一种病理过程，即胆结石导致慢性炎症，逐渐侵蚀周围结构。鉴于临床表现不具特异性，诊断需要高度怀疑。鉴于存在即将发生胆管炎、败血症和肝实质损伤的风险，建议早期行胆囊切除术并封闭瘘口进行治疗。
