Ali S, Anjum A, Khalid AR, Sultan MA, Noor S, Nashwan AJ. Unexpected finding of cholecystogastric fistula in a patient undergoing laparoscopic cholecystectomy: A case report. World J Clin Cases 2025; 13(19): 104148 [DOI: 10.12998/wjcc.v13.i19.104148]
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/
Unexpected finding of cholecystogastric fistula in a patient undergoing laparoscopic cholecystectomy: A case report
Sabtain Ali, Ayyub Anjum, Abdul Rauf Khalid, Muhammad Akbar Sultan, Safia Noor, Abdulqadir J Nashwan
Sabtain Ali, Registrar of Surgery, Bahria International Hospital Orchard, Lahore 54000, Punjab, Pakistan
Ayyub Anjum, West Surgical Ward, Mayo Hospital, Lahore 5400, Punjab, Pakistan
Abdul Rauf Khalid, Medical Officer, Bahria International Hospital Orchard, Lahore 5400, Punjab, Pakistan
Muhammad Akbar Sultan, Medical Officer, Lahore General Hospital, Lahore 5400, Punjab, Pakistan
Safia Noor, Medical Officer, Jinnah Hospital, Lahore 5400, Punjab, Pakistan
Abdulqadir J Nashwan, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
Author contributions: Sultan MA and Noor S contributed to data curation and methodology; Khalid AR contributed to manuscript writing, editing, and data collection; Ali S and Anjum A contributed to data analysis, resources, and software; Nashwan AJ contributed to conceptualization and supervision. All authors have read and approved the final manuscript.
Informed consent statement: Informed consent has been obtained from the patient.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
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/
Received: December 12, 2024 Revised: February 1, 2025 Accepted: February 20, 2025 Published online: July 6, 2025 Processing time: 97 Days and 23.9 Hours
Abstract
BACKGROUND
Gallbladder stones are a common occurrence, with a prevalence of approximately 10% in the Pakistani population. A rare but potentially fatal complication of gallstones is cholecystogastric fistulas. The underlying mechanism involves chronic inflammation due to cholelithiasis, causing gradual erosion and eventually leading to fistula formation.
CASE SUMMARY
We present a rare case of a cholecystogastric fistula in a 40-year-old female patient, successfully managed with an open surgical approach. The patient initially presented with a 6-month history of intermittent epigastric pain, nausea, and vomiting, which worsened over time. Laboratory investigations and abdominal ultrasound confirmed cholelithiasis, and laparoscopic cholecystectomy was planned. However, intraoperative findings revealed a cholecystogastric fistula, a rare complication of chronic gallstone disease. Given the dense adhesions between the gallbladder and the stomach, the procedure was converted to an open surgery. The fistula was divided, and a cholecystectomy was performed, along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch. The patient recovered uneventfully and was discharged on the third postoperative day.
CONCLUSION
This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis. The report discusses diagnostic challenges, surgical approaches, and a review of the current literature on managing such rare but serious complications of gallstones.
Core Tip: A rare and potentially fatal complication of gallstones, cholecystogastric fistulas often present with vague, non-specific symptoms and are commonly diagnosed intraoperatively. Early recognition through imaging, such as computed tomography scans showing pneumobilia and atrophied gallbladder, is crucial for proper surgical planning. The choice between open or laparoscopic surgery and a single-stage or two-stage procedure depends on factors like adhesion severity, surgeon expertise, and patient comorbidities. Early cholecystectomy is essential in preventing complications related to chronic cholecystitis.
