Cholecystoduodenocolic Fistula: An Unexpected Intraoperative Finding, a Surgical Challenge

The bilioenteric fistulas, first described in 1890 by Courvoisier, are found in 0.15% - 8% of biliary tract operations. Combined fistulas involving the gallbladder, duodenum and colon are extremely rare. We presented a case of 38 year female who presented to our OPD with complaints of pain right upper abdomen for seven months in whom a cholecysto-duodenocolic fistula (Figure 1 & Figure 2) was found during surgery which was repaired primarily. Gallstone disease is a common problem in hepatobiliary system and may rarely present as cholecysto-enteric fistula. The most common type of biliary enteric fistula is Cholecystoduodenal fistula (70%). Cholecysto-duodeno-colic (CDC) fistula is a rare complication of cholelithiasis. The standard treatment of IBF is cholecystectomy and repair of the fistulous opening. Although very rare a cholecystoduodenocolic fistula should be kept as a possibility when there are adhesions between GB, duodenum and colon. Conversion to open surgery should be considered early when the anatomy is not clear to prevent iatrogenic injury.