From the Research
A cholecystoduodenal fistula is primarily caused by chronic gallstone disease, as evidenced by the most recent study 1, which highlights the importance of considering this condition in patients with a history of gallstone disease presenting with gastrointestinal bleeding. The process begins with inflammation of the gallbladder (cholecystitis) due to obstruction by gallstones, leading to pressure necrosis of the gallbladder wall. As the inflammation progresses, adhesions form between the gallbladder and nearby structures, particularly the duodenum. Eventually, the persistent inflammation and pressure cause erosion through both organ walls, creating a direct passageway. Some key points to consider include:
- Gallstones account for approximately 90% of cases, as noted in the study 2
- Other less common causes include peptic ulcer disease, malignancies of the gallbladder or surrounding organs, abdominal trauma, and prior surgical interventions, as mentioned in the study 3
- Patients may present with symptoms of biliary disease such as right upper quadrant pain, nausea, vomiting, or jaundice, though some fistulas remain asymptomatic until complications like gallstone ileus develop, where a large stone passes through the fistula and causes intestinal obstruction, as discussed in the study 4
- The diagnosis of a cholecystoduodenal fistula can be challenging, and imaging studies such as ultrasound and CT scans may be necessary to confirm the diagnosis, as highlighted in the study 5
- Treatment of a cholecystoduodenal fistula typically involves surgical intervention, such as cholecystectomy and repair of the duodenum, as described in the study 1