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A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer
To cite this article: Brieau B, et al. A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer. Presse Med. (2017), http://dx.doi.org/10.1016/j.lpm.2017.04.009 Presse Med. 2017; //: ///
A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer Occlusion colique secondaire à une migration lithiasique : à propos d'un cas Case report A 59 year-old man was admitted in our department for abdominal pain, vomiting and general condition deterioration. He had no stool since two days and his abdomen was clinically distended. The patient had an advanced gallbladder cancer with synchronous peritoneal and hepatic metastases, and was treated since 12 months with a gemcitabine-based chemotherapy with partial response according to the RECIST criteria. We suspected an occlusive syndrome due to progression of the peritoneal carcinomatosis and also performed a computed tomography (CT) scan. The CT scan confirmed the occlusive syndrome with a colon dilatation and failed to identify a disease progression. Meanwhile, abdominal imaging found the migration of a large gallstone from the gallbladder to the colon due to
a cholecystocolonic fistula between the right colon and the gallbladder (figure 1a). The stone was impacted into the left colon (size: 65 40 55 mm) and corresponded to the aetiology of the occlusive syndrome (figure 1b). We concluded a variant of the Bouveret's syndrome, which classically corresponds to an ileus after the migration of a gallstone from the gallbladder to the duodenum, jejunum, or even ileum. A colonoscopy was performed attempting to remove the gallstone, but failed despite the use of several techniques (metallic snare, Dormia basket, intracoporeal laser lithotripsy). Finally, the patient underwent a surgical extraction with colostomy, improving substantially his condition and he was discharged from hospital 10 days later. His health status remained stable and he subsequently restarted the chemotherapy treatment. In this context, the most frequent diagnosis is a disease progression with compressive peritoneal metastases causing the occlusion. Surprisingly, the CT scan revealed the mechanic occlusion due to the gallstone migration. Cholecystotocolonic fistulas (CCF) are mostly asymptomatic, frequently diagnosed intraoperatively during cholecystectomy procedure. If present, symptoms are usually aspecific, such as chronic diarrhea; occlusive syndrome is exceptional. CCF are rare, accounting from 0.06 to 0.14% in case of cholecystectomy procedure and are widely considered to be the final stage of a long-lasting inflammatory process of the gallbladder caused by stones (chronic cholecystitis). It was exceptionally described in context of gallbladder
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
Figure 1 a: in coronal plan, the arrow indicates the fistula between the colon and the gallbladder; b: in coronal plan, the arrow indicates the large gallstone impacted in the left colon
1
tome xx > n8x > xx 2017
LPM-3330
To cite this article: Brieau B, et al. A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer. Presse Med. (2017), http://dx.doi.org/10.1016/j.lpm.2017.04.009
Letter to the editor
B. Brieau, M. Barret, S. Leblanc, A. Oudjit, R. Coriat
cancer: in an extensive review of the literature about CCF, only 4 out of the 231 reported cases corresponded to carcinomas [1], and underwent a surgical management. Early diagnosis is major because of the high mortality of this complication that may be related to the advanced age of the typical patient as well as other comorbidities and their impact on the risks associated with surgery. Recently, endoscopic techniques have demonstrated their efficacy managing "classic'' Bouveret' syndrome with obstructive gallstone in stomach, duodenum or ileum, using Dormia basket or laser lithotripsy. Laser lithotripsy has demonstrated his effectiveness for difficult bile duct stones [2], allowing to the fragmentation of the stone. This technique could require a long-lasting procedure, until 60 minutes of laser application for a centimetric gallstone. In our knowledge, our case is the first reporting an endoscopic attempt of gallstone extraction in case of left colon impaction, which unfortunately failed. Laser was applied only 30 minutes that is not sufficient in the light of the other published experience. Indeed, Mirante et al. have reported a successful gallstone extraction of the duodenum after fragmentation with laser lithotripsy in a case of Bouveret' syndrome [3]: laser was applied for a total of 200 minutes. In conclusion, although failing in our case, endoscopic approach potentially using laser lithotripsy should be considered as an option for obstructive gallstone from cholecystocolonic fistulas, but a long time of procedure should be planned before performing.
2
Disclosure of interest: the authors declare that they have no competing interest.
References [1]
[2]
[3]
Costi R, Randone B, Violi V, Scatton O, Sarli L, Soubrane O, et al. Cholecystocolonic fistula: facts and myths. A review of the 231 published cases. J Hepatobiliary Pancreat Surg 2009;16(1):8–18. Neuhaus H, Zillinger C, Born P, Ott R, Allescher H, Rosch T, et al. Randomized study of intracorporeal laser lithotripsy versus extracorporeal shoch-wave lithotripsy for difficult bile duct stones. Gastrointest Endosc 1998;47(5):327–34. Mirante V, Bertani H, Grande G, Manno M, Caruso A, Mangiafico S, et al. Effective endoscopic holmium laser lithotripsy in the treatment of a large impacted gallstone in the duodenum. Endoscopy 2015;47(Suppl. 1):UCTN: E485.
Bertrand Brieau1, Maximilien Barret1, Sarah Leblanc1, Ammar Oudjit2, Romain Coriat1 1 Hôpital Cochin, service de gastro-entérologie et oncologie digestive, université Paris-Descartes, unité Inserm U1016, Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France 2 Hôpital Cochin, service de radiologie, 27, rue du Faubourg-SaintJacques, 75014 Paris, France
Correspondence: Bertrand Brieau, Hôpital Cochin, service de gastroentérologie et oncologie digestive, université Paris-Descartes, Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France [email protected] Received 17 January 2017 Accepted 5 April 2017 Available online: http://dx.doi.org/10.1016/j.lpm.2017.04.009 © 2017 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2017
A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer Occlusion colique secondaire à une migration lithiasique : à propos d'un cas Case report A 59 year-old man was admitted in our department for abdominal pain, vomiting and general condition deterioration. He had no stool since two days and his abdomen was clinically distended. The patient had an advanced gallbladder cancer with synchronous peritoneal and hepatic metastases, and was treated since 12 months with a gemcitabine-based chemotherapy with partial response according to the RECIST criteria. We suspected an occlusive syndrome due to progression of the peritoneal carcinomatosis and also performed a computed tomography (CT) scan. The CT scan confirmed the occlusive syndrome with a colon dilatation and failed to identify a disease progression. Meanwhile, abdominal imaging found the migration of a large gallstone from the gallbladder to the colon due to
a cholecystocolonic fistula between the right colon and the gallbladder (figure 1a). The stone was impacted into the left colon (size: 65 40 55 mm) and corresponded to the aetiology of the occlusive syndrome (figure 1b). We concluded a variant of the Bouveret's syndrome, which classically corresponds to an ileus after the migration of a gallstone from the gallbladder to the duodenum, jejunum, or even ileum. A colonoscopy was performed attempting to remove the gallstone, but failed despite the use of several techniques (metallic snare, Dormia basket, intracoporeal laser lithotripsy). Finally, the patient underwent a surgical extraction with colostomy, improving substantially his condition and he was discharged from hospital 10 days later. His health status remained stable and he subsequently restarted the chemotherapy treatment. In this context, the most frequent diagnosis is a disease progression with compressive peritoneal metastases causing the occlusion. Surprisingly, the CT scan revealed the mechanic occlusion due to the gallstone migration. Cholecystotocolonic fistulas (CCF) are mostly asymptomatic, frequently diagnosed intraoperatively during cholecystectomy procedure. If present, symptoms are usually aspecific, such as chronic diarrhea; occlusive syndrome is exceptional. CCF are rare, accounting from 0.06 to 0.14% in case of cholecystectomy procedure and are widely considered to be the final stage of a long-lasting inflammatory process of the gallbladder caused by stones (chronic cholecystitis). It was exceptionally described in context of gallbladder
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
Figure 1 a: in coronal plan, the arrow indicates the fistula between the colon and the gallbladder; b: in coronal plan, the arrow indicates the large gallstone impacted in the left colon
1
tome xx > n8x > xx 2017
LPM-3330
To cite this article: Brieau B, et al. A rolling stone plugging the colon: Consequence of a cholecystocolonic fistula from gallbladder cancer. Presse Med. (2017), http://dx.doi.org/10.1016/j.lpm.2017.04.009
Letter to the editor
B. Brieau, M. Barret, S. Leblanc, A. Oudjit, R. Coriat
cancer: in an extensive review of the literature about CCF, only 4 out of the 231 reported cases corresponded to carcinomas [1], and underwent a surgical management. Early diagnosis is major because of the high mortality of this complication that may be related to the advanced age of the typical patient as well as other comorbidities and their impact on the risks associated with surgery. Recently, endoscopic techniques have demonstrated their efficacy managing "classic'' Bouveret' syndrome with obstructive gallstone in stomach, duodenum or ileum, using Dormia basket or laser lithotripsy. Laser lithotripsy has demonstrated his effectiveness for difficult bile duct stones [2], allowing to the fragmentation of the stone. This technique could require a long-lasting procedure, until 60 minutes of laser application for a centimetric gallstone. In our knowledge, our case is the first reporting an endoscopic attempt of gallstone extraction in case of left colon impaction, which unfortunately failed. Laser was applied only 30 minutes that is not sufficient in the light of the other published experience. Indeed, Mirante et al. have reported a successful gallstone extraction of the duodenum after fragmentation with laser lithotripsy in a case of Bouveret' syndrome [3]: laser was applied for a total of 200 minutes. In conclusion, although failing in our case, endoscopic approach potentially using laser lithotripsy should be considered as an option for obstructive gallstone from cholecystocolonic fistulas, but a long time of procedure should be planned before performing.
2
Disclosure of interest: the authors declare that they have no competing interest.
References [1]
[2]
[3]
Costi R, Randone B, Violi V, Scatton O, Sarli L, Soubrane O, et al. Cholecystocolonic fistula: facts and myths. A review of the 231 published cases. J Hepatobiliary Pancreat Surg 2009;16(1):8–18. Neuhaus H, Zillinger C, Born P, Ott R, Allescher H, Rosch T, et al. Randomized study of intracorporeal laser lithotripsy versus extracorporeal shoch-wave lithotripsy for difficult bile duct stones. Gastrointest Endosc 1998;47(5):327–34. Mirante V, Bertani H, Grande G, Manno M, Caruso A, Mangiafico S, et al. Effective endoscopic holmium laser lithotripsy in the treatment of a large impacted gallstone in the duodenum. Endoscopy 2015;47(Suppl. 1):UCTN: E485.
Bertrand Brieau1, Maximilien Barret1, Sarah Leblanc1, Ammar Oudjit2, Romain Coriat1 1 Hôpital Cochin, service de gastro-entérologie et oncologie digestive, université Paris-Descartes, unité Inserm U1016, Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France 2 Hôpital Cochin, service de radiologie, 27, rue du Faubourg-SaintJacques, 75014 Paris, France
Correspondence: Bertrand Brieau, Hôpital Cochin, service de gastroentérologie et oncologie digestive, université Paris-Descartes, Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France [email protected] Received 17 January 2017 Accepted 5 April 2017 Available online: http://dx.doi.org/10.1016/j.lpm.2017.04.009 © 2017 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2017