S3278 Chronic Cholecystitis Presenting With Incomplete Large Bowel Obstruction

Introduction: Chronic cholecystitis is a subacute condition caused by mechanical or functional dysfunction of emptying of the gallbladder. This long-standing inflammation may result in obstruction through gallstone translocation through a fistula, however this has not been reported as solely secondary to reactive changes. We present the case of a 68-year-old woman who developed a large bowel obstruction secondary to inflammatory changes from chronic cholecystitis. Case Description/Methods: A 68-year-old woman with a history of a noncancerous colon polyp, and no prior surgical history complains of crampy abdominal pain for several months. The pain is described as diffuse, only occasionally triggered by food with associated worsening nonbloody, nonbilious emesis, loose bowel movements and approximately 20 lb weight loss. A computed tomography abdomen showed acute cholecystitis and possible choleduodenal fistula. A dilated small bowel and ascending colon was noted, with a transition point near hepatic flexure. She was started on appropriate antibiotics with surgical and gastrointestinal consultation. Gastrografin enema showed evidence of incomplete obstruction with contrast in ascending colon, however consistent with possible extrinsic inflammatory changes; no fistula was identified. Magnetic resonance cholangiopancreatography confirmed cholecystitis, and a colonoscopy to rule out cancerous mass identified a large 30 mm polypoid mass, however pediatric scope was unable to be passed. Pathology from colonic biopsy confirmed reactive changes. She was discharged after tolerating diet, and continued improvement with stool habits over several months with plans for outpatient cholecystectomy. Discussion: Bowel obstruction secondary to cholecystitis often results in a fistulous tract, with gallstone passage blocking the intestinal lumen. In our patient, despite being unable to traverse the obstruction on colonoscopy the computed tomography with enema identified no fistulous tracts between gallbladder and bowel. Biopsy results obtained from colonoscopy noted reactive changes of the colon, and ruled out colon cancer at the hepatic flexure. With biopsy findings suggestive reactive changes, and gallstone effectively being ruled out with imaging studies, the most likely culprit of this patient’s large bowel stenosis is likely chronic inflammation. Post hospitalization, the patient noted symptomatic improvement with an additional 10 days of oral antibiotics and low fat diet to attempt to reduce colic symptoms and plans for outpatient cholecystectomy.