Fístula colecistogástrica como complicación de colecistitis crónica

Abstract

Objective: Characterize patients with cholecystogastric fistulas and identify the possible post- surgical complications that they may present. Materials and methods: Retrospective descriptive study of clinical case analysis. Discussion: Bilioenteric fistulas are an entity that can be defined as abnormal communication between the biliary system and the gastrointestinal tract and that can occur spontaneously or as in most cases due to a complication of untreated gallstones. Where the main objective of the treatment for this pathology is to achieve the decompression of the bile duct and prevent recurrences, with an expectant and conservative management of the originated fistula. since it can cause diverse clinical consequences that in some situations endanger the life of the patient. We present the case of a 55-year-old patient with no significant history who came to the emergency department of the Ambato regional hospital with an acute abdomen and who, through imaging and Tokyo criteria, has reached a diagnosis of cholecystitis, for which a decides to perform emergency laparoscopic cholecystectomy in which a cholecystogastric fistula is found incidentally with opening of the stomach towards the vesicular plastron and gastric wall necrosis in addition to subhepatic and perigastric abscesses, for which it is decided Date: June 2021. to perform debridement of the multiple adhesions, raffia of stomach in three planes, subtotal cholecystectomy and cholecystostomy, she was transferred to the ICU for 14 days after which she was discharged and followed up. Eight months after cholecystectomy, the patient presents a torpid clinical picture triggered by sepsis of biliary origin, for which the patient is admitted to the intensive care service with follow-up by general surgery, due to the complex resolution of her clinical picture and the need for a A surgical team experienced in hepatobiliary surgery activates the network and is referred to a tertiary center in this case to the Eugenio Espejo Specialties Hospital for biliary reconstruction and performance of Hepatojejunostomy where she was operated electively, thus resolving her pathological picture. Conclusion: It was determined that cholecystogastric fistulas are not so frequent clinical entities with reported incidences of less than 1.2 and 3% of biliary pathologies in hepatobiliary surgeries; being a medical challenge since the vast majority are clinically silent or present vague digestive symptoms, and there are no diagnostic modalities specific enough to make a preoperative diagnosis, so doctors should be aware of its possibility in patients with cholelithiasis of long duration and chronic cholecystitis. Once the fistula is detected intraoperatively, it is imperative to perform a cholecystectomy, cholecystostomy or percutaneous drainage, which allows decompression of the gallbladder and later, in a second stage, consider the repair of the existing fistula, if it warrants it or in patients with high surgical morbidity and mortality and poor response to conservative treatment.