Fístula colecistocolónica: abordaje dual endoscópico. Reporte de un caso

Cholecystocolonic fistula is an unusual and late complication of cholelithiasis. The symptoms usually are nonspecific and most cases are diagnosed intraoperatively. Our patient was a female, 75 years old, smoker, with a severe aortic stenosis history. She had a 6-month evolution diarrhea associated with weight loss, coagulopathy and aerobilia in abdominal ultrasound. On behalf of the clinic manifestations, cholecystocolonic fistula was suspected so an abdominal computer tomography scan and a cholangioresonance confirmed this suspicion. Given the patient comorbidities, we decided not to perform a surgical approach. An endoscopic retrograde cholangiography with extraction of choledocolithiasis and placement of a fully covered self-expanding metallic stent was associated with a video colonoscopy and closure of the colonic fistula with a clip device. The patient had a favourable evolution and was discharged on the second day post-procedure. After 3 months of follow-up, she did not present diarrhea and has recovered her weight loss and nutritional status. Given the unusual nature of the case and the significance of the preoperative diagnosis, which allowed us to carry out a minimally invasive treatment, we believe that its report is useful. We place special emphasis on the aerobic triad, alteration of the prothrombin concentration and chronic diarrhea that allowed us to suspect the diagnosis.