Pneumobilia, chronic diarrhea, vitamin K malabsorption: A pathognomonic triad for cholecystocolonic fistulas

Table 1 Systematic review of cases of cholecystocolic fistulas reported in the literature

Author (yr)	No. pts	Age (yr)	Etiology	Main clinical manifestation	Presence of pneumobilia	Means of fistula visualization	Treatment option preferred
Chatzoulis et al[14] (2007)	1M	52	Cholelithiasis (mirizzi syndrome type IV)	Diarrhea, RUQ pain, fever	+ (US, CT)	MRCP, ERCP	Cholecystectomy, fistula excision, Roux-en-Y bilio-enteric anastomosis
Wang et al[15] (2006)	1F	63	Gallbladder and CBD stone	RUQ pain	+	ERCP	Laparoscopic cholecystectomy, fistula closure
Singh et al[16] (2004)	1F	92	Gallstones	Melena	+	-	Conservative
Arvanitidis et al[17] (2003)	1M	72	Acute obstructive cholecystitis	Unexplained pneumobilia, history of RUQ pain	+ (US)	ERCP	Open cholecystectomy, fistula resection, exploration of CBD
Hussien et al[18] (2003)	1M	63	Xanthogra-nulomatous cholecystitis	Fever due to extraperitoneal abscesses	-	-	Cholecystectomy, fistula excision, closure of colon defect
Velayos Jiménez et al[9] (2003)	1F	79	Cholelithiasis	Chronic diarrhea, steatorrhea (?)	+ (US, CT)	BE	Conservative (antibiotics, vitamins)
De Keuleneer et al[19] (2002)	NR	NR	Cholelithiasis (Mirizzi syndrome type I)	Obstructive jaundice	-	ERCP	Cholecystectomy with Roux-en-Y hepato-enteric anastomosis
Ramos-De la Medina et al[20] (2002)	1F	48	Cholelithiasis	Lower gastro-intestinal bleeding	-	-	Open surgery
	1F	60	Gallbladder malignacy	Multiple hepatic abscesses	-	-
Dutta et al[21] (2002)	1F	65	NR	Diarrhea, weight loss, malabsorption (?)	+	BE, ERCP	Fistulectomy, cholecystectomy
Schoeters et al[22] (2002)	1F	81	NR	Incidental pneumobilia, RUQ pain	+ (PAF, US)	ERCP	NR
Fujitani et al[23] (2001)	1F	58	Cholelithiasis, chronic cholecystitis	RUQ pain	-	Intraoperatively	Laparoscopic cholecystectomy and fistula resection
Sam et al[24] (2001)	1F	75	Incidental (Crohn’s disease?)	Diarrhea	- (Air in gallbladder)	BE, Tc-99m chole-scintigraphy	NR
Inal et al[2] (1999)	1F	72	Chronic cholecystitis	Diarrhea, weight loss	+ (US)	BE	Open cholecystectomy, repair of the fistula
Kuo et al[25] (1999)	1F	65	Chronic cholecystitis	Diarrhea, fever, RUQ, jaundice	+ (PAF)	BE, ERCP	Cholecystectomy, fistulas division
Hida et al[26] (1999)	1F	61	Cholelithiasis	Incidental finding (BE screening), RUQ pain	-	BE	Laparoscopic stampling technic
Holst et al[27] (1999)	1F	76	Gallstone disease	Diarrhea, RUQ pain	-	BE	Open cholecystectomy, fistula resection
Reddy et al[28] (1998)	1F	72	History of acute cholecystitis	Incidental finding during laparoscopic cholecystectomy	-	-	Laparoscopic approach, tube caecostomy
Bornet et al[29] (1998)	NR	NR	Gallstone disease	Colonic gallstone obstruction	+ (CT)	CT?	None
Hession et al[13] (1996)	1F	70	Acute or chronic cholecystitis	Diarrhea	-	BE	NR
	1F	78		Diarrhea	-	BE
	1F	69		Diarrhea	-	BE
	1F	73		Diarrhea	-	BE
	1F	77		Colon ileus	+	BE
	1F	85		RUQ pain, diarrhea	+	BE
	1M	43		Melena	-	ERCP
Pérez Morera et al[30] (1996)	2F	NR	Gallstone disease	Colonic gallstone obstruction	+	BE (postoperatively)	Repair of the fistula at a later stage
Ibrahim et al[31] (1995)	1F	68	Cholelithiasis	Incidental finding during laparoscopic cholecystectomy, RUQ pain, diarrhea	-	Operative cholecystogramm	Laparoscopic approach
Gentileschi et al[32] (1995)	NR	NR	Gallstone disease	Severe diarrhea	-	BE	Laparoscopic approach
Prasad et al[33] (1994)	1F	67	NR	Incidental finding during laparoscopic cholecystectomy	-	Operative cholangiography	Laparoscopic approach
Swinnen et al[34] (1994)	NR	NR	Gallstone disease	Colonic gallstone obstruction	+ (US)	Colonoscopy & contrast fistulography	NR
Benage et al[7] (1990)	1F	78	Gallstone obstruction of CBD	Malabsorption (steatorrhea, osteomalacia, hypocalcemia)	-	ERCP	Open cholecystectomy, repair of the fistula, calcium & D3 supplementation
Sing et al[35] (1990)	1M	80	Cholelithiasis, CBD obstruction, (Billroth II?)	Diarrhea, weight loss, fat malabsorption	+ (US)	ERCP	Open cholecystectomy, fistula resection, T-tube in CBD
Caroli-Bosc et al[36] (1990)	2		Gallstones	Steatorrhea	-	ERCP	Open surgery
				Jaundice, fever	-	ERCP, cholescintigram	ERCP sphincterotomy
Patel et al[37] (1989)	1F	NR	Gallstone disease	Colonic gallstone obstruction	-	?	?
Anseline et al[38] (1981)	1F	90	Gallstone disease	Colonic gallstone obstruction	+ (X-ray contrast)	Intraoperatively	None

M: Male; F: Female; NR: Not reported; RUQ: Right upper quadrant; CBD: Common bile duct; PAF: Plain abdominal film; BE: Barium enema; US: Ultrasound examination; CT: Computed tomography; MRCP: MR cholangio-pancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.