Cholecystocolonic Fistula Associated With Advanced Mirizzi Syndrome Causing Chronic Diarrhea: Successful Treatment Using Cholangioscopy-Guided Lithotripsy and Surgery.

BACKGROUND

Cholecystocolonic fistula (CCF) is a rare complication of advanced Mirizzi syndrome (MS) and often presents with chronic watery diarrhea due to abnormal bile entry into the colon. The optimal role of endoscopic treatment in MS with CCF remains uncertain.

CASE SUMMARY: A 63-year-old man presented with three months of chronic watery diarrhea. Computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography showed an impacted cystic duct confluence stone, pneumobilia, and contrast passage into the colon, establishing the diagnosis of MS complicated by CCF. A biliary stent improved his symptoms, and peroral cholangioscopy-guided electrohydraulic lithotripsy subsequently enabled complete stone clearance. Cholangioscopy revealed no grossly apparent neoplastic lesions within the gallbladder. The patient subsequently underwent subtotal cholecystectomy with partial colectomy without biliary reconstruction. Histopathology revealed chronic cholecystitis without malignancy, and the postoperative course was uneventful.

CONCLUSION

A stepwise approach combining cholangioscopy-guided lithotripsy with targeted surgery can reduce operative complexity and facilitate safe management of advanced MS with CCF.