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Arch Surg. 2009;144(5):482.

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Answer: Cholecystocolonic Fistula Associated With Escherichia coli Liver Abscess

The cholecystocolonic fistula (CCF) represents 15% of all cholecystoenteric fistulas, thus being the second most frequent after the colecysto-duodenal fistula.¹ Unlike fistulas between the gallbladder and proximal gastrointestinal tract, often revealed by intestinal obstruction, more than 90%² of CCF cases are discovered during laparoscopic cholecystectomy. Such misdiagnosis may result in a challenging situation for the surgeon, who must achieve a diagnosis, usually while managing multiple adhesions, and must switch from a very low-morbidity surgery, sometimes during laparoscopy, to a procedure that is harder to perform and is usually in older patients with comorbidities.

In fact, symptoms of CCF are nonspecific, thus being neglected for years. Diarrhea^{1, 3-4} due to the malabsorption of biliary acids that bypass the terminal ileum and Bahuin valve, and right hypochondrium pain^{1, 5} are the most frequent symptoms of CCF, although their lack of specificity reduces their usefulness. Jaundice and hyperpyrexia are more helpful because they may prompt . . . [Full Text of this Article]

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Arch Surg. 2009;144(5):481.
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