A case of cholecystogastric fistula, complaining fever and epigastritis

Abstract

A 53-year-old lady was admitted to the hospital because of high fever and epigastritis persisting for three weeks. The patient had a history of hypertension since at age 47, and also she was diagnosed as cholelithiasis at age 49, which was left alone without any treatment.
The patient had a pain in the right hypochondrium and the bulbar conjunctivae were icteric.
Increase of bilirubin, transaminases, CRP and leukocytes were observed in blood test. Abdominal roentgenogram and CT showed pneumobilia, wall thickening of the gallbladder and the gallstone like calcification. We suspected internal biliary fistulae and performed gastroendoscopic study. At the center of the ulcer lesion, a small pit was found suggesting the fistula. Endoscopic retrograde cholangiography (ERC) and contrast examination of the upper gastrointestinal tract were performed and the fistula formation between gallbladder and the antrum of the stomach was confirmed with the contrast medium flow. Thus, surgical operation was performed with a diagnosis of cholecystogastric fistula.
Cholecystogastric fistula is very rare among the spontaneous internal biliary fistula, and difficult to make a preoperative diagnosis. Our case shows the importance of the image examinations, not only the contrast medium flowing through the fistula found by ERC and contrast examination of the upper gastrointestinal tract, but also abdominal roentgenogram and CT showing pneumobilia, direct observation of the fistula with gastroendoscopic study.