Operative management of cholecystogastric fistula as a rare complication of gallbladder empyema: A case report

Abstract

Introduction

Cholecysto-gastric fistula is a rare, life-threatening complication of cholelithiasis that presents significant challenge to surgeons. Early diagnosis can be obtained and surgical intervention can be planned as elective case. Dilemma comes when patient presenting with acute acute abdominal symptoms necessitating immediate surgery, decision-making becomes more complex increasing morbidity and mortality.

Presentation of case

A 59-year-old gentleman, was admitted for acute epigastric and right hyochondrium pain along with fever persisting for one week. The diagnosis of gallbladder empyema was retained. Emergency laparotomy revealed a cholecysto-gastric fistula, an inter hepatico-diaphragmatic abscess, and acute gangrenous cholecystitis. Surgical intervention included drainage of the abscess, cholecystectomy with placement of a trans-cystic drain, closure of the cholecysto-gastric fistula, and contact drainage.

Discussion

Cholecystogastric fistula a rare, life-threatening complication of cholelithiasis, The pathogenesis underlying is complicated. Despite improvements in imaging techniques, diagnosing remains challenging is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. The surgical management of cholecysto-enteric fistulas remains a contentious issue, with many surgeons favoring conversion to an open approach over laparoscopic surgery.

Conclusion

Cholecystogastric fistula, although rare, is associated with considerable morbidity and mortality, necessitating prompt diagnosis and early intervention. Advances in radiological and endoscopic techniques facilitate accurate and timely diagnosis, enabling the planning of appropriate surgical management. This brief report sheds light on the importance of a multidisciplinary team preventing a potentially fatal outcome.