title: Cholecystocolonic fistula: facts and myths. A review of the 231 published cases.
abstract: BACKGROUND
  Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula and is often discovered intraoperatively, resulting in a challenging situation for the surgeon, who is forced to switch to a complex procedure, often in old, unfit patients. Management of this uncommon but possible finding is still ill defined.
  
  
  METHODS
  An extensive review of 160 articles published from 1950 to 2006 concerning 231 cases of CCF was performed.
  
  
  RESULTS
  CCF is mostly an affliction of women in their sixth to seventh decades and is rarely diagnosed preoperatively. Chronic diarrhea is the key symptom in nonemergency patients, but, in one-fourth of cases, CCF presents with an acute onset, mostly biliary ileus. In one-fourth of patients, a second hepatobiliary abnormality is present, including gallbladder cancer in 2% of cases. In uncomplicated cases, diverting colostomy is not performed anymore, and laparoscopy treatment has been described in specialized centers. Symptomatic treatment of concomitant biliary ileus (without treating CCF) is a feasible option. Resolution of colonic biliary ileus by interventional endoscopy is reported.
  
  
  CONCLUSIONS
  CCF should be considered in differential diagnosis of diarrhea, especially in old, female patients. A possible second hepatobiliary abnormality should be always investigated. Extemporaneous frozen section should be performed if gallbladder cancer is suspected. Depending on clinical presentation, different treatments for CCF are indicated, ranging from minimally invasive procedures to extensive resection.
authors.affiliation: Service de Chirurgie Viscérale Digestive, Urologique et Plastique, CHI Poissy/Saint-Germain-en-Laye, Saint-Germain-en-Laye, France. renatocosti@hotmail.com
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.forename: Bruto
authors.initials: B
authors.lastname: Randone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Violi
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Sarli
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Thierry
authors.initials: T
authors.lastname: Montariol
mesh_terms: D001658:Biliary Fistula / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery