Transmural invasion of hepatic flexure of colon causing cholecystocolic fistula by aggressive gallbladder carcinoma
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Transmural invasion of hepatic flexure of colon causing cholecystocolic fistula by aggressive gallbladder carcinoma Amit Nandan Dhar Dwivedi1*, Satendra Kumar2, Samir Rana1 and BabuNandan Maurya1
Abstract Spontaneous enterobiliary fistulae are a complication of biliary disease or a disease of adjacent structures. Cholecystocolic fistulae are rare in relation to gallbladder carcinoma (GBC). Previous reports have presented images showing subtle findings suggestive of cholecystocolic fistula. We report the unusual spread and rare images of a case of cholecystocolicfistula,to highlight the aggressive nature of GBC and findings of gross transmural invasion of the colonic wall. The images acquired in all three planes define the anatomical and pathological extent conclusively. There are a higher number of GBC cases across the geographic belt of North India compared to the West. In this case, the patient’s pathology was extensive and unresectable, and therefore palliative and supportive care wasadvised. Keywords: Cholecystocolic fistula, Gallbladder carcinoma, Multidetector CT
Background The cholecystocolonic fistula is an uncommon but pertinent complication of gallbladder disease, occurring in 0.06 to 0.14% of patients with biliary disease [1,2]. Among the different types of cholecystoenteric fistulas, the cholecystoduodenal is the most common with lecystocolonic fistulas being the second most common [3]. Aggressive gallbladder carcinomas (GBCs) rarely invade into the adjacent duodenum and/or colon resulting in internal biliary fistula. Worldwide epidemiological studies have implicated dietary factors in the development of GBC. The ecological evidence indicates considerable geographic variation in the incidence of GBC. Variations in the incidence of various populations might be partly determined by dietary variations. Patients may present with non-specific symptoms such as diarrhea, malena and loss of weight. Barium studies of the gastrointestinal tract and colon are diagnostic. Multidetector computed tomography (MDCT) can demonstrate the fistulous communication and anatomical details in all three planes.
* Correspondence: [email protected] 1 Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India Full list of author information is available at the end of the article
Case presentation We discuss the case of a 48-year-old woman who presented with right hypochondrial pain, jaundice and melena. On examination there was severe jaundice and a lump in the right hypochondrium. The patient underwent an abdominal ultrasonography which showed gallbladder fossa mass infiltrating the portahepatis with proximal biliary dilatation. Fine needle aspiration cytology (FNAC) was undertaken and revealed high grade adenocarcinoma. The patient was advised MDCT evaluation. Contrast enhanced multiplanar CT (computed tomography; 64-slice LightSpeed GE scanner; GE Healthcare, Waukesha, WI, USA) with IV and oral co
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