Laparoscopic management of an unexpected cholecystogastric fistula discovered during common bile duct exploration: a case report and focused literature review.

INTRODUCTION AND

IMPORTANCE

Cholecystoenteric fistulas are rare complications of long-standing gallstone disease. Cholecystogastric fistula is the least common subtype and is often difficult to diagnose preoperatively due to nonspecific clinical and radiologic findings.

CASE PRESENTATION: A 72-year-old female with a history of cholelithiasis and recurrent choledocholithiasis presented with abdominal pain. Magnetic resonance cholangiopancreatography demonstrated a filling defect in the mid common bile duct with proximal biliary dilatation, consistent with obstructive choledocholithiasis. She underwent laparoscopic common bile duct exploration and cholecystectomy. Intraoperatively, dense adhesions were encountered, revealing an unexpected cholecystogastric fistula, and a gallstone was removed from the stomach through the fistulous tract. The fistula was repaired laparoscopically, and the cholecystectomy was completed. The postoperative course was uneventful.

DISCUSSION: Cholecystogastric fistula is a rare entity that often remains undetected preoperatively despite modern imaging techniques. In many cases, the diagnosis is made intraoperatively due to subtle radiologic findings. Advances in laparoscopic techniques have made minimally invasive management feasible in selected cases when performed by experienced surgeons.

CONCLUSION

Cholecystogastric fistula is a rare and challenging diagnosis. This case highlights the importance of intraoperative vigilance and suggests that laparoscopic management may be feasible in carefully selected patients when performed by experienced surgeons.