Abstract
Gastric Outlet Obstruction arising from Adhesions Secondary to Chronic Calculous Cholecystitis with Cholecystoduodenal Fistula Formation in an Immunocompetent Male: A Case Report
Christmae Maxine P. Solon, MD 1, Daniel Benjamin Diaz, MD1
1Section of Gastroenterology, Department of Internal Medicine, Cebu Doctors’ University Hospital
Background: Gastric outlet obstruction (GOO) can result from intrinsic and extrinsic obstruction of the pyloric channel or the duodenum. Here we present a rare case of GOO attributed to dense adhesions between the gallbladder and duodenum secondary to chronic cholecystitis with choledochoduodenal fistula formation in an adult immunocompetent male.
Clinical Presentation: A 43 year old with no comorbidities consulted for a history of recurrent epigastric pain, vomiting and weight loss. CT scan of the whole abdomen showed irregular thickening in the proximal duodenum with secondary GOO with a lamellated cholelithiasis within the gallbladder and pneumobilia. A cholecystoduodenal fistula was considered. Exploratory laparotomy revealed extensive fibrosis and acute on chronic inflammation of the gallbladder with dense adhesions to surrounding structures. Dissection revealed a gallstone impacted in and adherent to the wall of the gallbladder and a fistula opening into the duodenum. In this case, the patient had no definite evidence of impacted gallstone in the duodenum and the dense adhesions secondary to chronic inflammation of the gallbladder caused the narrowing in duodenum causing extrinsic compression and GOO. Biopsy specimens taken were negative for malignancy.
Conclusion: This highlights that preoperative and intraoperative differential diagnosis of GOO is a challenge. Chronic calculous cholecystitis through intense inflammation can present as a rare cause of GOO. The degree of GOO is dependent on the degree of inflammation from cholecystitis causing worsening intraluminal narrowing. Optimal treatment plan should take into consideration the underlying etiology of the GOO.
Keywords: Gastric Outlet Obstruction, Cholecystitis, Cholecystoduodenal Fistula, Complications
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
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