doiSerbia

Spontaneous cholecystoduodenal fistula - spectrum of complications

Šaponjski Dušan (Clinical Center of Serbia, First Surgical Clinic, Department of Abdominal Radiology, Belgrade, Serbia)
Đurić-Stefanović Aleksandra (Clinical Center of Serbia, First Surgical Clinic, Department of Abdominal Radiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Janković Aleksandra (Clinical Center of Serbia, First Surgical Clinic, Department of Abdominal Radiology, Belgrade, Serbia)
Mitrović-Jovanović Milica (Clinical Center of Serbia, First Surgical Clinic, Department of Abdominal Radiology, Belgrade, Serbia)
Kmezić Stefan (Clinical Center of Serbia, First Surgical Clinic, Clinic for Abdominal Surgery, Belgrade, Serbia)
Mihajlović Slađana (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Dragiša Mišović Clinical Hospital Centre, Belgrade, Serbia)
Popović Ivan (Stefan Visoki General Hospital, Smederevska Palanka, Serbia)
Šaranović Đorđije (Medigroup General Hospital, Belgrade, Serbia + University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia and Herzegovina)

Introduction. Spontaneous cholecystoduodenal fistula is a rare complication of the gallbladder calculosis. Bowel obstruction is the complication in less than 1% of these patients. The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones is typical for gallstone ileus. In only 1–3% of the patients with bowel obstruction by ectopic gallstone the localization of obstruction is in the duodenum, and it is called Bouveret syndrome. The rarest complication is a floating non-obstructing gallstone trapped in the stomach. Outline of cases. We present three elderly female patients with persistent abdominal pain and known gallbladder calculosis in the patients’ histories. Plain radiography of the thorax and abdomen and ultrasound were performed as the first choice and contrast-enhanced computer tomography (CT) was done subsequently. In the first patient, CT and magnetic resonance imaging (MRI) showed signs of pneumobilia, cholecystoduodenal fistula, and the presence of the gallstone in the stomach. The iodine contrast X-ray swallow test revealed a cholecysto-duodenal bulb fistula and floating calculus in the stomach, confirmed by endoscopy. In the second patient with persistent abdominal pain, CT and barium swallow test showed signs of pneumobilia, cholecystoduodenal fistula, and two ectopic gallstones obstructing duodenum – Bouveret syndrome. The third case showed signs of the Rigler triad – typical signs of gallstone ileus. Conclusion. Spontaneous cholecystoduodenal fistula is a rare condition with possible complications such as Bouveret syndrome, gallstone ileus and floating, non-obstructive gallstones in the stomach, as the rarest possible complication. CT, MRI with magnetic resonance cholangiopancreatography, as well as the contrast X-ray swallow test can be very helpful in the detection of the bilio-enteric fistula and ectopic gallstones.

Keywords: cholecystoduodenal fistula, Bouveret syndrome, Rigler triad, complications, ectopic gallstone