A Case of Cholecystoduodenal Fistula Treated Successfully by T-tube Duodenostomy

Abstract

We report a case of cholecystoduodenal fistula presenting with gallstone ileus that was successfully treated by T-tube duodenostomy. A 75-year-old woman visited our emergency room with the chief complaint of vomiting. Abdominal plain CT showed bowel obstruction caused by a gallstone measuring 45×25mm in size in the small intestine. Abdominal contrast-enhanced CT showed a cholecystoduodenal fistula. Thus, the patient was diagnosed as having gallstone ileus caused by a cholecystoduodenal fistula. Since the bowel obstruction did not improve with conservative therapy, a one-stage surgery consisting of enterolithotomy, cholecystectomy and fistulectomy was performed. Because the duodenal defect with chronic inflammation could not be closed by suture or with an omental patch, a T-tube duodenostomy was performed. Thereafter, the patient was discharged without any postoperative complications. T-tube duodenostomy is a simple and effective procedure for cases of cholecystoduodenal fistula with severe inflammation of the fistula.