Unexpected finding of cholecystogastric fistula in a patient undergoing laparoscopic cholecystectomy: A case report.

BACKGROUND: Gallbladder stones are a common occurrence, with a prevalence of approximately 10% in the Pakistani population. A rare but potentially fatal complication of gallstones is cholecystogastric fistulas. The underlying mechanism involves chronic inflammation due to cholelithiasis, causing gradual erosion and eventually leading to fistula formation.

CASE SUMMARY: We present a rare case of a cholecystogastric fistula in a 40-year-old female patient, successfully managed with an open surgical approach. The patient initially presented with a 6-month history of intermittent epigastric pain, nausea, and vomiting, which worsened over time. Laboratory investigations and abdominal ultrasound confirmed cholelithiasis, and laparoscopic cholecystectomy was planned. However, intraoperative findings revealed a cholecystogastric fistula, a rare complication of chronic gallstone disease. Given the dense adhesions between the gallbladder and the stomach, the procedure was converted to an open surgery. The fistula was divided, and a cholecystectomy was performed, along with primary repair of the gastric defect using a double-layer suture and reinforcement with an omental patch. The patient recovered uneventfully and was discharged on the third postoperative day.

CONCLUSION: This case highlights the importance of considering cholecystogastric fistula in patients with vague gastrointestinal symptoms and chronic cholelithiasis. The report discusses diagnostic challenges, surgical approaches, and a review of the current literature on managing such rare but serious complications of gallstones.