Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree d...Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.展开更多
重症患者因病情严重且复杂,需长期卧床,常伴有免疫能力下降、肌肉萎缩,以及消化功能紊乱,导致患者出现营养不良等症状[1]。肠内营养是ICU患者重要的营养支持方式,早期采用肠内营养支持不仅有助于胃肠道功能恢复,改善肠黏膜屏障功能,还...重症患者因病情严重且复杂,需长期卧床,常伴有免疫能力下降、肌肉萎缩,以及消化功能紊乱,导致患者出现营养不良等症状[1]。肠内营养是ICU患者重要的营养支持方式,早期采用肠内营养支持不仅有助于胃肠道功能恢复,改善肠黏膜屏障功能,还能有效提高患者的免疫力,但在进行肠内营养治疗过程中常因吸收不良、营养液渗透压较高等原因会出现肠内营养相关性腹泻(enteral nutrition related diarrhea, ENAD)[2]。展开更多
文摘Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.
文摘重症患者因病情严重且复杂,需长期卧床,常伴有免疫能力下降、肌肉萎缩,以及消化功能紊乱,导致患者出现营养不良等症状[1]。肠内营养是ICU患者重要的营养支持方式,早期采用肠内营养支持不仅有助于胃肠道功能恢复,改善肠黏膜屏障功能,还能有效提高患者的免疫力,但在进行肠内营养治疗过程中常因吸收不良、营养液渗透压较高等原因会出现肠内营养相关性腹泻(enteral nutrition related diarrhea, ENAD)[2]。
