EURORAD ESR

Case 15149

Spontaneous benign cholecysto-colonic fistulisation

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 64 year(s)
 
 
  • Figure 1
    Plain chest and abdomen radiographs
     

    Postero-anterior chest (a) and upright abdominal (b) radiographs showed gastric overdistension with abundant intraluminal stagnant fluid and air-fluid level (arrowa). Very scarce air in the small bowel and colon.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Postero-anterior chest (a) and upright abdominal (b) radiographs showed gastric overdistension with abundant intraluminal stagnant fluid and air-fluid level (arrows). Very scarce air in the small bowel and colon.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 2
    Unenhanced and post-contrast multidetector CT
     

    Pre-(a) and post-contrast (b-e) images confirmed overdistended stomach (o) with abundant stagnant fluid and air-fluid level. The gallbladder showed contracted lumen (*), marked circumferential mural thickening...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Post-contrast (b-e) images confirmed overdistended stomach (o) with air-fluid level and fluid-filled duodenal bulb (+). The gallbladder showed contracted lumen (*), marked circumferential mural thickening...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    The hepatic flexure and proximal transverse colon showed marked mural thickening (arrow) with oedematous submucosa and enhancing mucosa.

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Focused oblique-coronal and sagittal reformations (d,e) showed fluid-attenuation fistula (thin arrows) piercing through the thickened gallbladder and communicating with the oedematous colonic flexure (arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Focused oblique-coronal and sagittal reformations (d,e) showed fluid-attenuation fistula (thin arrows) piercing through the thickened gallbladder and communicating with the oedematous colonic flexure (arrows).

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 3
    Post-surgical contrast-enhanced CT
     

    Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
Postero-anterior chest (a) and upright abdominal (b) radiographs showed gastric overdistension with abundant intraluminal stagnant fluid and air-fluid level (arrowa). Very scarce air in the small bowel and colon.
 
Postero-anterior chest (a) and upright abdominal (b) radiographs showed gastric overdistension with abundant intraluminal stagnant fluid and air-fluid level (arrows). Very scarce air in the small bowel and colon.
 
Pre-(a) and post-contrast (b-e) images confirmed overdistended stomach (o) with abundant stagnant fluid and air-fluid level. The gallbladder showed contracted lumen (*), marked circumferential mural thickening (arrowheads).
 
Post-contrast (b-e) images confirmed overdistended stomach (o) with air-fluid level and fluid-filled duodenal bulb (+). The gallbladder showed contracted lumen (*), marked circumferential mural thickening (arrowheads) with stratified enhancement.
 
The hepatic flexure and proximal transverse colon showed marked mural thickening (arrow) with oedematous submucosa and enhancing mucosa.
 
Focused oblique-coronal and sagittal reformations (d,e) showed fluid-attenuation fistula (thin arrows) piercing through the thickened gallbladder and communicating with the oedematous colonic flexure (arrows).
 
Focused oblique-coronal and sagittal reformations (d,e) showed fluid-attenuation fistula (thin arrows) piercing through the thickened gallbladder and communicating with the oedematous colonic flexure (arrows).
 
Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small bowel loops consistent with ileus.
 
Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small bowel loops consistent with ileus.
 
Coronal (a) and axial (b,c) images showed early postoperative status after cholecystectomy plus resection of hepatic flexure of the colon. Note simple fluid collection occupying gallbladder fossa (§), distended small bowel loops consistent with ileus.
 
 
 
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