Wandering Gallstones (Gallbladder Fistulae)

Case Report

Austin Surg Case Rep. 2016; 1(1): 1003.

Wandering Gallstones (Gallbladder Fistulae)

Pillay Y*

Department of General Surgery, Prince Albert Parkland Health Region, Canada

*Corresponding author: Yagan Pillay, Department of General Surgery, Prince Albert Parkland Health Region, Saskatchewan, Canada

Received: December 12, 2015; Accepted: January 18, 2016; Published: January 20, 2016


Wandering gallstones Gallbladder fistulae are a rare surgical entity and usually present with complications of the fistulae such as gallstone ileus or bowel perforation. They usually present in an elderly patient cohort with extensive medical morbidities. This case report looked at two types of gallbladder fistulae and their outcomes. In both cases, the complications of the fistula was managed and not the fistula itself. The intestinal obstruction for the gallstone ileus as well as the gallstone coleus was surgically treated in both cases which necessitated a laparotomy on both occasions. The gallstone ileus had an enterotomy and gallstone removal. This was closed primarily. The gallstone coleus could not be primarily repaired after stone extraction and a Hartman`s resection was performed. In both cases the patient had a stormy post-operative course but did eventually make a complete recovery. One patient developed septic shock while the other developed a pulmonary embolus. This required an intensive care admission for both patients. Gallbladder fistulae are often managed conservatively and the gallbladder is usually treated surgically at a later date. In many case reports the gallbladder itself is never dealt with and this may be detrimental to patient care as an occult malignancy will need to be actively excluded. This can occur in 2-6 percent of cases. Cholecystitis or cholangitis can also occur in 5-10 percent of cases.

Keywords: Gallbladder fistulae; Cholecystoduodenal; Cholecystocolonic gallstone ileus; Gallstone coleus


Gallbladder fistulae are quite rare with a reported incidence of 0.9% [1]. This case report discusses two types of fistulae, cholecystoduodenal and cholecystocolonic as well as their subsequent management. Both patients presented with intestinal obstruction and no signs or symptoms of biliary tract disease. In both cases surgery was performed for the complications of the fistulae while the fistulae themselves were conservatively managed.

Case 1: Cholecystoduodenal fistula

An 85 year old Caucasian female was referred with intestinal obstruction of five days duration. She had nausea and bile stained vomiting. Clinically she was stable and not jaundiced. She had abdominal pain and distention but no signs of rebound or guarding. Her rectal exam was normal with no obvious masses. She had a fracture of the right hip that was treated with Open Reduction and Internal Fixation (ORIF) and developed the intestinal obstruction while convalescing in hospital. She had no medical history and her surgical history was significant only for the ORIF. Her blood results were normal and her Computerized Tomography (CT) scan showed a large gallstone in the distal ileum causing intestinal obstruction (Figure 2). Her gallbladder also showed multiple large gallstones and a cholecystoduodenal fistula (Figure 1). She signed an informed consent for an exploratory laparotomy. At surgery a large gallstone was removed from the distal ileum through an enterotomy and primary closure (Figure 3). Her gallbladder had ruptured with an empyema in the right upper quadrant which was drained and all her gallstones removed (Figure 4). A Blake drain was placed in the right subhepatic space to drain the gallbladder. The gallbladder was not removed and the cholecystoduodenal fistula could not be clearly identified due to excessive inflammation and fibrosis. Her recovery was quite eventful and required an Intensive Care Unit (ICU) admission with Total Parenteral Nutrition (TPN). She was also put on antibiotics and inotropic support. She eventually made a complete recovery and was sent home after one month. The ruptured gallbladder was never treated surgically and four years later she has completely recovered with no further episodes of abdominal pain or jaundice.