Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding

Abstract

Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal hemorrage and even with a gallstone illeous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. Although a diagnosis of cholecystocolic fistula is rarely suspected clinically, it should be considered in elderly patients with unexplained pneumobilia or unexplained persistent diarrhea. The standard treatment for these fistulas is cholecystectomy and excision of the fistula. Endoscopic sphincterotomy is an option in the treatment of elderly unfit patients as it can cause spontaneous healing of the fistula by reducing increased biliary pressure. Also, spontaneous resolution of the fistula has been described, although it is not very common. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as a lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decisión was made not to proceed with invasive treatment. She had a good evolution and was asintomatic two months later.