Abstract
A 69-year-old woman was found to have a pneumobilia on an abdominal ultrasonographic examination while she was undergoing treatments for diabetes. There was a history of cholelithiasis which was diganosed at the age of 40 and was left untreated. A cholecystogastric fistula was recognized by gastric endoscopic fistulography. Blood chemistry revealed mild abnormalities of liver function. At the operation, the gallbladder was found to be severely atrophic, leaving only the cholecystic duct, with a fistula formation to the antrum. The gastric wall around the fistula was removed together with the gallbladder. Food residues were found in the common bile duct. Marked inflammation of the cholecystic duct was observed.
In Japan, 14 cases of cholecystogastric fistula have been reported in the literature. However, no previous case has been reported that food residues are in the biliary duct. Some have the opinion that if there are no symptoms of cholangitis, fistulas to the upper gastrointestinal tracts may be left intact. However, since food residues which get into the biliary tract may cause serious cholangitis, surgical therapy at an early stage is recommended even for asymptomatic patients in principle.
