A case of cholecystocolonic fistula successfully diagnosed by colonoscopy

Abstract

A man in his seventies with diabetes mellitus was admitted to our hospital with a high fever. The patient had undergone steroid pulse therapy against sudden hearing loss five days prior to admission. A blood test showed elevations in inflammatory and hepatic parameters. Computed tomography (CT) showed swelling of the gallbladder with intracholecystic gas. The CT also identified a hepatic abscess at the perigallbladder. Emphysematous cholecystitis with peri-cholecysto-liver abscess was suspected. Percutaneous transhepatic drainage of the gallbladder and abscess was performed under ultrasonographic guidance. Preoperative colonoscopy showed a small orifice in the transverse colon near the hepatic flexure. Fistulography was performed, visualizing the fistula and gallbladder. Chinese ink was injected endoscopically near the orifice of the fistula. Choleystectomy was performed on Day 27 after admission. Ink-injection was extremely useful in locating the cholecystocolonic fistula during the procedure. The patient was discharged from the hospital on Day 101.