A Case of Cholecystocolic Fistula with Shock due to Gallbladder Hemorrhage

Abstract

Cholecystocolic fistulas and gallbladder hemorrhage are rare complications of cholecystolithiasis. Here, we report an extremely rare case of calculous cholecystitis followed by cholecystocolic fistula and gallbladder hemorrhage in a 60-year-old man. One year and two months after the initial diagnosis of cholecystocholedocholithiasis, the patient visited our hospital with sudden diarrhea and bloody stool. Abdominal computed tomography (CT) and colonic endoscopy suggested cholecystocolic fistula and colonic hemorrhage, which was believed to have occurred after spontaneous hemostasis. After admission, while undergoing preoperative examinations, he had bloody stool again and experienced shock. Abdominal CT revealed arterial gallbladder hemorrhage, and cholecystocolic fistula with gallbladder hemorrhage was diagnosed. He temporarily recovered from shock with rapid fluid infusion and red blood cell transfusion and underwent emergency laparotomy. A fistula was found between the gallbladder and transverse colon, and partial transverse colon resection and cholecystectomy were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. Although cholecystocolic fistula is rarely complicated by gallbladder hemorrhage, it must be recognized as an emergency condition requiring prompt diagnosis and treatment.