Abstract
Gallstone ileus is a relatively rare entity. It often affects elderly people and its definite therapeutic methods have not been established as yet cancerning on the cause of this entity, a fistula between the gallbladder and GI tract. Recently we experienced a case of gallbladder carcinoma which was detected after an internal biliary fistula had been left alone in a woman in her eighties. She was seen at the hospital because of vomiting in 2000, when abdominal CT scan disclosed an impacted gallstone in the small intestine and gallstone ileus was diagnosed. Partial excision of the small intestine was performed for the part where the gallstone was impacted, considering her advanced age. The patient developed anemia in 2003. The gallbladder wall was thickened and invasion of gallbladder carcinoma to the duodenum was revealed. Bleeding from the portion of duodenum to where gallbladder carcinoma invaded was diagnosed, and cholelcystectomy under laparotomy and partial duodenectomy including the invaded portion were performed. The histopathological diagnosis was poorly differentiated adenocarcinoma of the gallbladder with a cholecystoduodenal fistula. No continuity between the fistula and cancer was noted.
A total of five cases of gallbladder carcinoma complicated with internal biliary fistula, including our case, have been reported in Japan. From the standpoint of preventing gallbladder carcinoma, internal biliary fistula must be treated by cholecystectomy and closure of the fistula as active as we can.
