# Cholecystoenteric Fistula: A Single-Center Experience of Seven Cases with Unusual Complications of Gallstone Disease

## TL;DR

This study examines seven cases of cholecystoenteric fistulas, a rare complication of gallstone disease, focusing on surgical management and outcomes at a single center.

## Contribution

The paper provides insights into the surgical challenges and outcomes of a rare condition with a small, single-center cohort.

## Key findings

- Cholecystoenteric fistulas were often diagnosed intraoperatively due to nonspecific symptoms.
- Laparoscopic surgery was attempted in 57.14% of cases but required conversion to open surgery in some.
- Postoperative complications included surgical site infections and one death.

## Abstract

Background: Cholecystoenteric fistulas (CEFs) are rare complications of chronic calculous cholecystitis, often diagnosed intraoperatively due to their nonspecific clinical presentation and challenges in preoperative detection. This study analyzes the surgical management and outcomes of CEFs at a tertiary care center.

Methods: A retrospective analysis was conducted on all patients who underwent surgery for CEF in the hepatopancreaticobiliary unit of the Department of Surgery at the All India Institute of Medical Sciences, Rishikesh, India, between June and December 2024. Data on preoperative characteristics, biochemical parameters, intraoperative findings, surgical techniques, conversion rates, and postoperative outcomes were collected and analyzed.

Results: Seven patients were included, with a mean age of 55.6 years (range: 49-69 years). Abdominal pain was the most common symptom (seven, 100%), while cholangitis was present in three (42.86%) cases. Gallstones were found in all patients (seven, 100%) and bile duct stones in two (28.57%). Multiple fistulas were observed in four (57.14%) cases, with cholecystocolonic fistulas (CCFs) and cholecystoduodenal fistulas (CDFs) being the most common combinations. Laparoscopic surgery was attempted in four (57.14%) cases but required conversion to open surgery. Bilioenteric anastomosis with Roux-en-Y hepaticojejunostomy was performed in three (42.86%). Postoperative complications included surgical site infections in two (28.57%) of the cases, and one (14.29%) died in the postoperative period. The mean hospital stay was 13.4 ± 3.8 days.

Conclusion: Cholecystoenteric fistula remains a diagnostic and surgical challenge due to its nonspecific presentation and intraoperative detection. While preoperative imaging can aid in diagnosis, most cases are identified intraoperatively, necessitating modifications in the surgical approach. Advances in laparoscopic techniques have reduced conversion rates, but complex cases still require open surgery. Further studies with larger cohorts are needed to refine diagnostic and therapeutic strategies.