Annals of medicine and surgery (2012) · 2026
Cholecystocolonic fistula with ruptured cystic artery pseudoaneurysm presenting as massive per rectal bleeding: a case report.
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Chaulagain Uttam, Khanal Kapil, Gautam Naveen, Pokhrel Kailash Mani, Gaurav Bishal, Gyawali Sushil, Thapa Rima, Oli Abinash
Аннотация
INTRODUCTION AND IMPORTANCE: Cholecystocolonic fistula and cystic artery pseudoaneurysm are rare complications of gallbladder disease. Their coexistence with massive lower gastrointestinal bleeding is extremely rare and potentially fatal.
CASE PRESENTATION: A 47-year-old male presented with severe acute cholecystitis, followed by massive per rectal bleeding and hypovolemic shock. Contrast enhanced CT revealed a cholecystocolonic fistula with a cystic pseudoaneurysm. The patient underwent emergency open cholecystectomy, primary colon repair, and diversion ileostomy. Postoperative histopathology confirmed chronic cholecystitis without malignancy. The ileostomy was successfully closed 8 weeks later, and the patient recovered well.
CLINICAL DISCUSSION: This rare bleeding mechanism may lead to diagnostic delays. Contrast-enhanced CT is crucial for identifying the source of bleeding, while surgery remains the definitive treatment for patients with cholecystoenteric fistulas.
CONCLUSION: This case describes a rare cause of lower GI bleeding. Early identification and timely surgery are crucial to avoiding fatal outcomes.
CASE PRESENTATION: A 47-year-old male presented with severe acute cholecystitis, followed by massive per rectal bleeding and hypovolemic shock. Contrast enhanced CT revealed a cholecystocolonic fistula with a cystic pseudoaneurysm. The patient underwent emergency open cholecystectomy, primary colon repair, and diversion ileostomy. Postoperative histopathology confirmed chronic cholecystitis without malignancy. The ileostomy was successfully closed 8 weeks later, and the patient recovered well.
CLINICAL DISCUSSION: This rare bleeding mechanism may lead to diagnostic delays. Contrast-enhanced CT is crucial for identifying the source of bleeding, while surgery remains the definitive treatment for patients with cholecystoenteric fistulas.
CONCLUSION: This case describes a rare cause of lower GI bleeding. Early identification and timely surgery are crucial to avoiding fatal outcomes.