Spontaneous cholecystocolonic fistula: a model situation for bile acid diarrhea and fatty acid diarrhea as a consequence of a disturbed enterohepatic circulation of bile acids.

Fistulas between the biliary and gastrointestinal tract complicate 12% of cases with cholecystitis. Communications of the biliary tract occur with decreasing frequency into the duodenum, colon and stomach. Clinical symptoms of cholecysto-colonic fistulas are chills and temperature elevation indicating ascending cholangitis. As bile acids bypass the small intestine, diminished fat absorption results. The unusual amount of bile acids in the colon delays water absorption, causing bile acid diarrhea. A pneumocholangiogram is seen in only 50% of the cases. Barium enema will visualize the fistula most often.