SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Odyssey: A Case of Cholecystocolonic Fistula and Liver Abscess

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This case describes a 59-year-old incarcerated man who presented with abdominal pain, fever, and vomiting and was found to have complex hepatobiliary disease. Initial CT imaging showed a distended, inflamed gallbladder and a large fluid collection near the right hepatic dome, consistent with a liver abscess. He improved temporarily with antibiotics but was readmitted with persistent symptoms. Further workup with ultrasound, HIDA scan, and MRCP revealed acute cholecystitis, choledocholithiasis, a cholecystocolonic fistula between the gallbladder and hepatic flexure of the colon, and associated colon inflammation.<br /><br />Management required a multidisciplinary approach. The patient underwent ERCP for common bile duct stone removal, followed by surgery. Intraoperatively, the hepatic flexure was densely adherent to the gallbladder and liver, necessitating right hemicolectomy with ileocolic anastomosis, drainage of the liver abscess, cholecystectomy, and fistula repair. Pathology showed severe hemorrhagic xanthogranulomatous gallbladder inflammation. His postoperative recovery was uncomplicated, and he was discharged on oral antibiotics.<br /><br />The report emphasizes that cholecystocolonic fistula is a rare but serious late complication of gallstone disease, occurring in about 0.1% of cholecystectomies and carrying significant morbidity and mortality. Because symptoms are often nonspecific and classic signs may be absent, diagnosis can be difficult. This case highlights the importance of maintaining suspicion for CCF in patients with recurrent abdominal symptoms, biliary disease, and colonic thickening, as timely recognition and intervention can prevent further deterioration.

Asset Subtitle

Umme Jannatul Ferdaush

Meta Tag

Author List Qamar Iqbal, Umme Jannatul Ferdaush

Category Clinical Vignettes

Concept Cholecystocolonic Fistula

Concept Gallstone Disease

Concept Community-Acquired Acute Cholecystitis

Concept Pyogenic Hepatic Abscess

Concept Choledocholithiasis

Distinguished Non-Finalist

Presenter Organization Tidalhealth

Presenting Author Umme Jannatul Ferdaush

Track Adult

Keywords

cholecystocolonic fistula

acute cholecystitis

choledocholithiasis

liver abscess

gallstone disease

ERCP

right hemicolectomy

xanthogranulomatous cholecystitis

biliary obstruction

hepatobiliary disease

Cholecystocolonic Fistula

Gallstone Disease

Community-Acquired Acute Cholecystitis

Pyogenic Hepatic Abscess

Choledocholithiasis