Cholecystoenteric Fistulae—Our Experience

The development of a cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis and it is usually seen to develop in patients with long-standing disease. An incidence of 3–5% has been reported in patients with cholelithiasis and 0.15–4.8% of patients undergoing biliary surgeries may have a CEF (Chowbey et al. J Laparoendosc Adv Surg Tech 16:467–472, 2006). The most common cholecystoenteric fistulae are of the cholecystoduodenal variety (70%), followed by cholecystocolic (8 to 26.5%) and cholecystogastric fistulae (Safaie-Shirazi et al. Surg Gynecol Obstet 137:769–772, 1973; Balent et al. Hawaii J Med Public Health 71:155–157, 2012). In this report, we share our experience of cholecystoenteric fistulae to highlight the presentation, intraoperative findings, and management. Retrospective review of patients with CEF encountered in our experience between 2003 and 2016. Patients admitted for laparoscopic cholecystectomy during this period were involved in the series and patients having cholecystoenteric fistulae were analyzed in detail and their picture is discussed. Among 2450 cholecystectomies encountered, a total of 35 patients had cholecystoenteric fistulae. There were 15 males and 20 females in the age range of 33–76 and with a mean of 55 years. Twenty-eight of the 32 (80%) patients were over 50 years of age. The most common type of fistula was cholecystoduodenal fistula (CDF) and was detected in 32 (91.4%) patients. Other types encountered were cholecystocolic fistula in two patients (5.71%) and cholecystogastric fistula in one (2.857%) patient. Ultrasound was the basic investigation. All cases were diagnosed intraoperatively. Overall 23 patients (65.71%) required a laparotomy. The remaining 12 (34.28%) cases were managed completely by the laparoscopic approach. Earlier in the cases, feeding jejunostomy was regularly used which became occasional in the later part of series. Cholecystoenteric fistulae are rare complication of long-standing gall stone disease. In the era of laparoscopy, many of these cases can be dealt laparoscopically. Low tolerance should be kept for conversion so that patient gets the best possibility of dealing with the condition in the same sitting without added complications.