From the Guidelines
Gallbladder invasion into the duodenum is a serious condition that requires prompt medical attention, and it is most commonly referred to as a cholecystoduodenal fistula, which is an abnormal connection between the gallbladder and the duodenum. This condition can lead to significant morbidity, mortality, and a decrease in quality of life if not treated properly 1.
Definition and Causes
Gallbladder invasion into the duodenum, or cholecystoduodenal fistula, typically occurs as a complication of severe gallstone disease, where chronic inflammation causes the gallbladder wall to erode and eventually create an opening into the adjacent duodenum. This condition most commonly results from long-standing gallstone disease, particularly when a large gallstone presses against the gallbladder wall and the nearby duodenal wall, causing inflammation, pressure necrosis, and eventual perforation between the two organs.
Symptoms and Complications
Patients may experience symptoms like abdominal pain, nausea, vomiting, and sometimes jaundice, though some patients remain asymptomatic until complications develop. Potential complications include gallstone ileus (intestinal obstruction caused by a large gallstone passing through the fistula into the intestine) or infection.
Treatment
Treatment typically involves surgical intervention to remove the gallbladder (cholecystectomy) and repair the fistula. The surgery may be performed as an open procedure or laparoscopically, depending on the specific circumstances and the surgeon's expertise. According to the 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy 1, prompt identification and management of bile duct injuries, including those involving the duodenum, are crucial to prevent long-term sequelae and improve patient outcomes.
Key Considerations
It is essential to note that bile duct injuries, including cholecystoduodenal fistulas, are complex and require prompt identification and management to prevent significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life 1. Close cooperation between gastroenterologists, radiologists, and surgeons is of utmost importance in the management of these conditions.
From the Research
Definition and Implications
Gallbladder invasion into the duodenum refers to a condition where the gallbladder, which is a part of the digestive system responsible for storing bile, invades or infiltrates into the duodenum, the first part of the small intestine. This condition can be associated with various gallbladder pathologies, including cancer, as discussed in 2 and 3.
Clinical Significance
The invasion of the gallbladder into the duodenum can lead to various clinical presentations, including abdominal pain, nausea, vomiting, and potentially, gastric outlet obstruction, as seen in Bouveret's syndrome 4, 5. The management of this condition depends on the underlying cause and can range from surgical intervention to endoscopic treatments.
Diagnostic Approaches
Accurate imaging assessment is crucial for the diagnosis of gallbladder pathologies, including invasion into the duodenum. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used imaging modalities, with each having its specific role in the diagnostic process, as outlined in 6.
Treatment Options
Treatment options for gallbladder invasion into the duodenum vary based on the extent of invasion, the presence of malignancy, and the patient's overall health status. Surgical resection, including duodenal sleeve resection or distal gastrectomy with resection of the first part of the duodenum, may be considered in cases of gallbladder cancer with duodenal involvement, as discussed in 2. For cases like Bouveret's syndrome, endoscopic removal of the obstructing gallstone, potentially using laser lithotripsy, is a preferred treatment approach, especially in elderly patients or those with significant comorbidities 5.