Management of concomitant cholecystoduodenal and cholecystocolonic fistulas with sigmoid colonic gallstone: a case report.

Cholecystoduodenal fistula and cholecystocolonic fistula are rare complications of gallstone pathology. A 62-year-old female presented to our surgical assessment unit with abdominal pain and vomiting. A computed tomographic scan revealed complex biliary-enteric fistulas. The fistulas involved the gallbladder, duodenum, and colon, with evidence of partial gastric outlet obstruction secondary to a gallstone in the proximal duodenum. Furthermore, imaging revealed a large gallstone impacted proximal to the diverticular stricture in the sigmoid colon. A minimally invasive approach to resolve the fistula was unsuccessful; endoscopic retrograde cholangiopancreatography and sigmoidoscopy to dislodge the gallstones failed. This led to a laparotomy with jejunal enterotomy for stone removal and a Hartmann's procedure to address the impacted gallstone and the sigmoid diverticular stricture. Furthermore, the repair of both fistulae was performed during the index operation at the second operation, while dealing with unexpected colostomy necrosis.