Wang CY, Chiu SH, Chang WC, Ho MH, Chang PY. Cholecystoenteric fistula in a patient with advanced gallbladder cancer: A case report and review of literature. World J Clin Cases 2023; 11(36): 8519-8526 [PMID: 38188217 DOI: 10.12998/wjcc.v11.i36.8519]
Corresponding Author of This Article
Ping-Ying Chang, MD, PhD, Chief Physician, Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 114, Taiwan. max-chang@yahoo.com.tw
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chun-Yu Wang, Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Sung-Hua Chiu, Wei-Chou Chang, Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Meng-Hsing Ho, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ping-Ying Chang, Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Wang CY contributed to manuscript writing, editing, and data collection; Chiu SH and Chang WC prepared the figures; Ho MH completed the surgery; Chang PY were responsible for manuscript modification; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping-Ying Chang, MD, PhD, Chief Physician, Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 114, Taiwan. max-chang@yahoo.com.tw
Received: August 29, 2023 Peer-review started: August 29, 2023 First decision: September 28, 2023 Revised: October 12, 2023 Accepted: December 7, 2023 Article in press: December 7, 2023 Published online: December 26, 2023 Processing time: 114 Days and 18.5 Hours
Abstract
BACKGROUND
Cholecystoenteric fistula (CEF) involves the formation of a spontaneous anomalous tract between the gallbladder and the adjacent gastrointestinal tract. Chronic gallbladder inflammation can lead to tissue necrosis, perforation, and fistulogenesis. The most prevalent cause of CEF is chronic cholelithiasis, which rarely results from malignancy. Because the symptoms and laboratory findings associated with CEF are nonspecific, the condition is often misdiagnosed, presenting a challenge to the surgeon when detected intraoperatively. Therefore, a preoperative diagnosis of CEF is crucial.
CASE SUMMARY
We present the case of a 57-year-old male with advanced gallbladder cancer (GBC) who arrived at the emergency room with persistent vomiting, abdominal pain, and diarrhea. An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second portion of the duodenum and transverse colon. We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula (CDF) or a cholecystocolonic fistula (CCF). He underwent multiple examinations, including esophagogastroduodenoscopy, an upper gastrointestinal series, colonoscopy, and magnetic resonance cholangiopancreatography; the results of these tests confirmed a diagnosis of synchronous CDF and CCF. The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon. His symptoms improved with supportive treatment while hospitalized. He initiated oral targeted therapy with lenvatinib for further anticancer treatment.
CONCLUSION
The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
Core Tip: Cholecystoenteric fistulas are rarely associated with malignancy, and synchronous cholecystoduodenal and cholecystocolonic fistulas are even rarer. We present the case of a 57-year-old male with advanced gallbladder cancer complicated by synchronous cholecystoduodenal and cholecystocolonic fistulas. He presented with persistent vomiting, abdominal pain, and diarrhea. We also review 30 cases of gallbladder cancer-related cholecystoenteric fistulas published between 1973 and 2023. We performed a statistical analysis of clinical symptoms, imaging findings, and management. Our aim is to share our experience with diagnosis and surgical treatment of this condition and offer our insights to guide future clinical decision-making.
