# Intraoperative Discovery and Laparoscopic Management of a Cholecystocolonic Fistula: A Case Report

## TL;DR

A rare gallbladder-to-colon connection was discovered during surgery and successfully treated using laparoscopic techniques in an elderly patient.

## Contribution

Demonstrates successful laparoscopic management of a cholecystocolonic fistula discovered during surgery.

## Key findings

- Cholecystocolonic fistulas are often diagnosed intraoperatively due to nonspecific symptoms and poor imaging sensitivity.
- Laparoscopic management of CCF is feasible with advanced surgical expertise and can lead to successful patient recovery.
- Maintaining a high suspicion for CCF in patients with chronic cholecystitis improves diagnostic and treatment outcomes.

## Abstract

Cholecystocolonic fistula (CCF) is a rare complication of chronic cholecystitis, characterised by an abnormal connection between the gallbladder and colon. It predominantly affects elderly patients with a history of gallstone disease and chronic inflammation. It is often difficult to diagnose preoperatively due to nonspecific symptoms, low sensitivity on current available imaging, and is often discovered intraoperatively. A high index of suspicion for a CCF should be maintained in patients with longstanding chronic cholecystitis, even when preoperative imaging is unrevealing. Surgeons should be prepared for altered anatomy and inflammation at operation and adjust their strategy accordingly to optimise patient outcomes. The laparoscopic approach is feasible and requires advanced laparoscopic expertise. Management varies from enterolithotomy in cases of emergency obstruction to fistula repair and cholecystectomy in elective cases. We report the case of a 63-year-old male with a history of gallstones and acute cholecystitis who underwent elective laparoscopic cholecystectomy. Intraoperatively, a CCF was identified and successfully managed via dissection and stapling of the fistulous tract with subsequent cholecystectomy. The patient recovered uneventfully and remained asymptomatic at follow-up.