Reminder of important clinical lesson: Is live problem better than dead cert?

摘要

Cholecystoduodenal fistula is a type of biliary enteric fistula that can occur as a result of chronic cholecystitis. The majority of cases are diagnosed and their subsequent management planned intraoperatively. Previous reports have focused on successful laparoscopic management. We report three cases of elective cholecystectomy that were diagnosed intraoperatively with a cholecystoduodenal fistula (CDF). The first two cases were managed laparoscopically. In case 3 further continuation of surgery would have subjected the patient to significant risk of further harm. Instead the patient underwent cholecyststomy with insertion of Foley's catheter and venting gastrostomy. All three patients made a full recovery postoperatively. CDF can be of varying severity. Our third case highlights the use of damage limitation surgery when carrying on is at risk of harm. Treatment therefore needs to be tailor made for each fistula identified.