A combined cholecystoduodenocolic and gastrocolic fistula with a common orifice in the colon: A case report.

Introduction: Gallbladder fistulas primarily connect to the duodenum (up to 83.3 % of cases) or colon (up to 24.5 %), with rare connections to other gastrointestinal organs. This report documents the clinical, pathological, and laboratory features and the management of a unique case involving a combined cholecystoduodenocolic and gastrocolic fistula with a common orifice in the colon.

Presentation Of The Case: A 46-year-old Iranian male with methadone addiction was hospitalized on December 12, 2024, due to abdominal pain, significant weight loss, and severe diarrhea with melena, who had delayed seeking medical attention because methadone alleviated his symptoms.

Discussion: Biliary fistulae can involve multiple organs and often present with non-specific symptoms, complicating diagnosis. Imaging revealed severely hypoechoic tissue in the gallbladder, suggesting a fistula. Upper endoscopy showed only a duodenal ulcer fistulized to the transverse colon, allowing the endoscope probe to be easily inserted into the colon without pressure. The surgical approach included cholecystectomy, resection and anastomosis of the involved colon, antrectomy, and removal of a portion of the proximal duodenum (D1), followed by a Billroth II reconstruction.

Conclusion: Simultaneous fistulization involving the gallbladder, stomach, duodenum, and colon is possible, though rare. This case underscores the importance of thorough individualized surgical approaches to optimize outcomes in similar cases.