Cholecystocolonic fistula with ruptured cystic artery pseudoaneurysm presenting as massive per rectal bleeding: a case report.

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.