IDDF2018-ABS-0249 Spontaneous cholecystocolonic fistula in an elderly male: a rare cause of massive lower gi bleeding

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Abstract

Background

Biliary enteric fistulas are often incidental findings. When asymptomatic usually no treatment is necessary but when they present with significant complication, surgery is warranted. Cholecystocolonic fistulas are uncommon and when present is usually associated with significant biliary disease. This paper aims to present an evenly atypical manifestation of this variant and much more that it presents in a very rare manner in the form of lower GI Bleeding.

Methods

We present a case of a 61-year-old male with Acute Myelogenous Leukaemia with no established biliary disease. He was post-appendectomy with loop ileostomy. He complained of recurrent abdominal pain with hematochezia.

Results

Plain film of the abdomen revealed gas distended bowel loops in the disorganised pattern. Initial colonoscopy prior to the contemplated takedown of ileostomy was done revealing an ascending colon stricture and colitis. Anaemia and infection were addressed. The abdominal pain persisted, and he had massive hematochezia, 2nd look colonoscopy revealed an ulcerated area oozing with blood and bile flowing into the ascending colon hence a fistula was suspected. The patient did not respond to conservative management of the bleeding hence he underwent Right hemicolectomy and cholecystectomy with adhesiolysis and takedown of ileostomy which confirmed the diagnosis of cholecystocolonic fistula and was further supported by the histopathologic findings.

Results

The patient improved post-operatively and was discharged subsequently.

Conclusions

Be prudent in handling atypical scenarios in a morbid and complicated patient. A stepwise approach and a high index of suspicion especially in unusual situations can often lead us to the correct diagnosis.

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