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Gallbladder

Miscellaneous non-tumor

Fistula


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 13 February 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Biliary-enteric fistulas found in 0.2 to 5.0% of patients with biliary tract surgery for non-malignant disease (Surgeon 2010;8:67)
● 90% due to cholelithiasis, 10% due to penetrating peptic ulcers of stomach or duodenum
● Complications: gallstone ileus
● Mortality: 15%

Sites
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● From gallbladder in 90%, biliary tract in 10%
● Usually to duodenum, also colon

Pathophysiology
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● Gallstones cause inflammation and necrosis of gallbladder or bile duct wall, leading to intestinal adhesions, leading to fistula

Clinical features
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● Abdominal pain, diarrhea, dyspeptic symptoms, nausea, and weight loss
● Most can be managed laparascopically

Diagnosis
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● Air within biliary tree by Xray, vomiting or passing a large gallstone

Case reports
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● 59 year old woman with cholecystocolic fistula (Saudi J Gastroenterol 2009;15:42)

Clinical images
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Right transverse colon with gall stone in fistula

End of Gallbladder > Miscellaneous non-tumor > Fistula


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