Maldonado GEL, Pizaña RMP, Urraza RI, Correa BG, Cruz CLM

Language: Spanish
References: 15
Page: 118-121
PDF size: 224.49 Kb.

ABSTRACT

Introduction: Cholecystoduodenal fistula is an infrequent clinical entity with reported incidences ranging between 0.15 and 5% of all biliary diseases. The cholecysto-duodenal fistulas represent 75 to 80% of cholecystoenteric fistulas. Most are clinically silent or have vague digestive symptoms. We present the following clinical case since it is a rare pathology of the bile duct and most of the time is found incidentally in the transoperative period. Case report: A 67-year-old male patient with no pathological personal history, with onset of current condition one month ago with pain on his right hypochondrium with right infrascapular irradiation that is exacerbated with cholecystokinetics, gallbladder ultrasound with 4 mm walls, gallstones of 15 and 20 mm, common bile duct of 5 mm in diameter, laboratory tests with leukocytes of 11,700/mm³ with 76% neutrophils, hemoglobin of 12.6 g/dL, glucose of 98 mg/dL, total bilirubin 0.37 mg/dL, direct bilirubin 0.2 mg/dL, pyruvate glutamic transaminase 36 U/L, oxalacetic glutamic transaminase 22 U/L, amylase 35 U/L, prothrombin time 12 seconds, INR 0.8, thromboplastin time 25 seconds. Scheduled for elective laparoscopic cholecystectomy with transoperative findings of gallbladder with thickened wall, with firm adhesions to the bottom of the first portion of the duodenum with a cholecistoduodenal fistula and a 1 cm in diameter fistulous orifice, gallstones of 5 and 7 mm in the interior of the gallbladder and a 3 mm cystic duct. Cholecystectomy was performed with four ports, performing separation of the gallbladder and duodenum at the level of the fistula. The duodenum was closed with polyglycolic and polypropylene suture in two planes and a closed drainage was placed. The patient progressed satisfactorily starting the oral intake on the third day and discharge on the fifth postoperative day. Conclusions: It’s not always possible to diagnose this type of fistula preoperatively and we normally diagnose them as a transoperative finding. Currently, many of these cases of cholecysto-duodenal fistulas are solved by laparoscopic surgery taking advantage of the benefits of this type of approach.

REFERENCES

1. Glenn F, Reed C, Grafe WR. Biliary enteric fistula. Surg Gynecol Obstet. 1981;153:527-531.

2. Chandar VP, Hookman P. Choledochocolonic fistula through acystic duct remnant. A case report. Am J Gastroenterol. 1980;74:179-181.

3. Yamashita H, Chijiiwa K, Ogawa Y, Kuroki S, Tanaka M. The internal biliary fistula-reappraisal of incidence type, diagnosis and management of 33 consecutive cases. HPB Surgery. 1997;10:143-147.

4. Angrisani L, Corcione F, Tartaglia A, Tricarico A, Rendano F, Vincenti R et al. Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery. Surg Endosc. 2001;15:1038-1041.

5. Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol. 2002;97:249-254.

6. Salazar-Lozano C, Rocha-Guevara ER, Vargas-Gismondi A, de La Fuente-Lira M, de Obaldía-Zeledón RE, Cordero-Vargas C. Íleo biliar y fístula colecistoduodenal. Informe de un caso. Cir Ciruj. 2006;74:199-203.

7. Rodríguez HJ, Codina CA, Gironès VJ, Roig GJ, Figa FM, Acero FD. Íleo biliar: resultado del análisis de una serie de 40 casos. Gastroenterol Hepatol. 2001;24:489-494.

8. Carlei F, Lezoche E, Lomanto D, Schietroma M, Paganini A, Sottili M et al. Cholecystoenteric fistula is not a contraindication for laparoscopic cholecystectomy: report of five cases treated by laparoscopic approach. Surg Laparosc Endosc. 1997;7:403-406.

9. Bennett LC, Hewko J. Cholecystoduodenal fistula; report of a case complicated by complete obliteration of the gallbladder. Am J Surg. 1952;83:228-232.

10. Velez M, Mule J, Brandon J, Kannegieter L. Laparoscopic repair of a cholecystoduodenal fistula. Surg Endosc. 1991;5:221-223.

11. Oka M, Yoshimoto Y, Ueno T, Yoshimura K, Maeda Y, Tangoku A. Treatment of cholecystoduodenal fistula by laparoscopy. Surg Laparosc Endosc Percutan Tech. 1999;9:213-216.

12. Sanjeev Kumar Sareen Cholecystoduodenal fistula is not the contraindication for laparoscopic surgery. World Journal of Laparoscopic Surgery. 2011;4:41-46.

13. Latic A, Latic F, Delibegovic M, Samardzic J, Kraljik D, Delibegovic S. Succcessful laparoscopic treatment of cholecystoduodenal fistula. Med Arh. 2010;64:379-380.

14. Chowbey PK, Bandyopadhyay SK, Sharma A, Khullar R, Soni V, Baijal M. Laparoscopic management of cholecystoenteric fistulas. J Laparoendosc Adv Surg Tech A. 2006;16:467-472.

15. Xiang-yang Li, Xin Zhao, Peng Zheng, Xiao-Ming Kao, Xiao-Song Xiang and Wu Ji. Laparoscopic management of cholecystoenteric fistula: A single-center experience. J Int Med Res. 2017;45:1090-1097.