What are the key learning points from a young female patient who underwent laparoscopic cholecystectomy (surgical removal of the gallbladder using a minimally invasive technique) and was found to have two separate cholecystoenteric fistulae (abnormal connections between the gallbladder and the intestine), including a cholecysto-colic (between the gallbladder and the colon) and a cholecysto-duodenal (between the gallbladder and the duodenum) fistula?

From the Guidelines

The key learning points from this case are the importance of approaching all laparoscopic cholecystectomies with caution, the need for robust support systems, and the rarity of dual cholecystoenteric fistulae in a young patient. This case highlights the potential for unexpected complexity during surgery, even in patients who appear to be straightforward cases preoperatively 1. The discovery of two separate cholecystoenteric fistulae, including a cholecysto-colic and a cholecysto-duodenal fistula, is particularly unusual in a young patient with a relatively short disease history.

Key Considerations

• The patient's history of calculous cholecystitis and subsequent flare-ups treated by her GP were not fully known to the surgical team, emphasizing the need for thorough preoperative work-up and communication 1.
• The successful completion of the procedure laparoscopically despite the unexpected complexity highlights the importance of having experienced surgeons and robust support systems in place 1.
• The case also underscores the need for proper postoperative follow-up pathways, including emergency equipment availability, to ensure the best possible outcomes for patients 1.

Management and Prevention

• Optimal strategies for the prevention of bile duct injuries, such as those that may occur in the context of cholecystoenteric fistulae, include technical and procedural considerations that must be adapted based on anatomical factors, the patient’s clinical status, disease factors, and the surgeon’s experience 1.
• The application of precision biliary surgery is recommended for promoting standardized management of bile duct injuries and related conditions 1.

Conclusion is not allowed, so the response ends here.

From the Research

Key Learning Points

• The presence of cholecystoenteric fistulae, including cholecysto-colic and cholecysto-duodenal fistulae, is a rare complication of gallstone disease, affecting 3-5% of patients with cholelithiasis 2.
• Laparoscopic management of cholecystoenteric fistulae is safe, feasible, and associated with rapid postoperative recovery, even in patients with complicated cholecystolithiasis 2, 3, 4.
• A high degree of suspicion is mandatory for the diagnosis of cholecystoenteric fistulae during laparoscopic cholecystectomy, and a stapled cholecystofistulectomy may be the procedure of choice to avoid contamination of the peritoneal cavity 2.
• The types of cholecystoenteric fistulae that can occur include:
  • Cholecystoduodenal fistulae (between the gallbladder and the duodenum) 2, 3, 4
  • Cholecystocolic fistulae (between the gallbladder and the colon) 2, 3, 4
  • Cholecystogastric fistulae (between the gallbladder and the stomach) 2, 4
  • Cholecystojejunal fistulae (between the gallbladder and the jejunum) 4
• Laparoscopic treatment of cholecystoenteric fistulae can be successfully performed without open conversion, even in patients with acute cholecystitis or a previous history of abdominal operation 4, 5.
• The use of endostaplers or intracorporeal sutures can be effective in managing cholecystoenteric fistulae during laparoscopic cholecystectomy 2, 4.