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SonoPhile

A gallbladder-duodenal fistula detected primarily with the use of ultrasound imaging, and subsequently confirmed by computed tomography. The patient is a 54-year-old woman who was admitted with upper abdominal pain. The fistula was caused by chronic cholecystitis, however no gallstones were present in the duodenum. Surgical management was undertaken for the patient, and the recovery was uneventful.

Gallbladder-duodenal fistula detected by ultrasound

Significance of Ultrasonography:

  • Played a pivotal role in diagnosing the cholecystoduodenal fistula.

  • Initiated the diagnostic pathway that led to surgical intervention.

Conclusion

  • Patient Profile:

    • 54-year-old woman with a history of Ischemic Heart Disease (IHD).

    • Presented to the emergency department with epigastric pain, recurring over two months.

  • Clinical Examination:

    • No signs of peritonitis, negative Murphy’s sign.

    • Lab results showed no cholestasis or acute inflammation.

  • Diagnostic Imaging:

    • Emergency Ultrasound (US):

      • Revealed gallstones and attachment of bowel loops (likely duodenum) to gallbladder.

      • Detected air bubbles suggestive of gallbladder-duodenum fistula.

    • Follow-up Ultrasound (3 days later):

      • Showed thickened gallbladder walls, multiple stones, and air within gallbladder wall.

    • Computed Tomography (CT):

      • Confirmed findings of air in biliary tracts, dilated common bile duct, and visible fistula canal.

  • Treatment:

    • Cholecystectomy:

      • Performed 12 days after initial presentation.

      • Fistula sutured, gallbladder removed.

  • Postoperative Course:

    • Discharged one week later without complications.

    • Patient's condition was generally good upon discharge.

Gallbladder with thickened walls (arrow) and duodenum (open arrow) with gas bubbles in and between both structures. Arrowhead – gas bubble moving through fistula.

Credit to: Jaguś, D., Karthik, A., Tan, Z. Y., Mlosek, R. K., & Białek, E. (2020). Gallbladder-duodenal fistula detected by ultrasound - a case report. Journal of ultrasonography, 20(82), e214–e217. https://doi.org/10.15557/JoU.2020.0036

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