A rare encounter with cholecysto-colonic fistula: A comprehensive case study

Cholecysto-colonic fistula is a rare complication of calculous cholecystitis. It can also occur following previous surgeries, or in association with gallbladder carcinoma. Although the majority of patients remain asymptomatic, some may present with symptoms such as abdominal pain, vomiting, fever, jaundice, diarrhea, lower gastrointestinal bleeding, or sepsis. Diagnosis is challenging and typically requires a comprehensive diagnostic work-up or is incidentally made during surgery. This report presents a case involving an 84-year-old man with diabetes and hypertension, diagnosed with a spontaneous cholecysto-colonic fistula that mimicked acute cholecystitis. Diagnostic confirmation was achieved through imaging studies, including computed tomography and contrast-enhanced computed tomography. The patient underwent surgery which required conversion from a laparoscopic to an open approach due to extensive adhesions. The fistula was surgically removed, and the colonic defect was repaired. The patient’s postoperative course was complicated by paralytic ileus and surgical site infection, but he recovered well and was discharged without further complications. Histopathological examination confirmed acute necrotizing cholecystitis. Cholecysto-colonic fistula remains a significant consideration in patients with recurrent cholecystitis and gastrointestinal symptoms. Early diagnosis and appropriate surgical intervention are crucial to prevent serious complications.