What is the prognosis for a patient with cholecystoduodenal fistula who refuses surgery?

From the Guidelines

The prognosis for a patient with cholecystoduodenal fistula who refuses surgery is generally guarded, with potential for both spontaneous improvement and serious complications. Without surgical intervention, patients may experience persistent symptoms including abdominal pain, nausea, vomiting, and diarrhea. Conservative management typically involves antibiotics for infections (such as ciprofloxacin 500mg twice daily or metronidazole 500mg three times daily for 7-14 days during acute episodes), pain management with acetaminophen or NSAIDs, and a low-fat diet to reduce biliary symptoms. Some key points to consider in the management of these patients include:

• Patients should be monitored regularly for complications including gallstone ileus (intestinal obstruction), malabsorption, weight loss, and rarely, cholangitis or sepsis.
• Without surgery, the fistula may persist indefinitely, though some cases resolve spontaneously if the underlying inflammation subsides and the gallstone burden is minimal.
• The mortality risk increases significantly if complications develop, particularly in elderly patients or those with comorbidities.
• Patients refusing surgery should understand that emergency intervention may become necessary if life-threatening complications occur, and they should seek immediate medical attention for worsening abdominal pain, fever, jaundice, or signs of intestinal obstruction, as suggested by the 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis 1.
• Gallbladder drainage may be an option in patients who failed conservative management and who present with strict contraindications for surgery, as recommended by the guidelines 1.
• Non-Operative Management (NOM) may be considered for patients refusing surgery or those who are not suitable for surgery, with a suggestion to consider alternative treatment options for patients who fail NOM and who still refuse surgery or patients who are not suitable for surgery 1.

From the Research

Prognosis of Patient with Cholecystoduodenal Fistula Refusing Surgery

• The prognosis for a patient with cholecystoduodenal fistula who refuses surgery is not directly addressed in the provided studies, as they primarily focus on the diagnosis and surgical treatment of the condition 2, 3, 4, 5, 6.
• However, it can be inferred that refusing surgery may lead to increased risk of complications, such as perforation and necrosis, as mentioned in the study by 3.
• The studies suggest that cholecystoduodenal fistula is a rare complication of gallstone disease, and its diagnosis can be challenging due to non-specific symptoms 3, 6.
• Surgical treatment, including laparoscopic approaches, is often the primary treatment for cholecystoduodenal fistula, and it has been shown to be effective in managing the condition 2, 4, 5.
• The prognosis for patients with cholecystoduodenal fistula who undergo surgery is generally good, with excellent clinical outcomes reported in several studies 2, 4, 5.
• However, without surgery, the patient may be at risk of developing further complications, such as cholangitis, bowel obstruction, or gallstone ileus, as reported in the study by 6.