TREATMENT OF CHOLECYSTOCOLIC FISTULA BY LAPAROSCOPY

Cholecystocolonic fistula is an unusual complication of biliary tract disease. Many of the signs and symptoms of these fistulas are nonspeci fic, so the diagnosis is often not suspected preoperatively. It is imp ortant to make the diagnosis then to prevent fecal contamination when the fistula is divided. We recently encountered a patient who, while u ndergoing laparoscopic cholecystectomy, was found to have a fistula be tween the gallbladder and the proximal transverse colon. Important fea tures in the management of this case are (1) maintaining a high index of suspicion for the presence of this complication, (2) use of cholecy stography to establish the diagnosis, and (3) use of laparoscopic stap ling techniques to divide the fistula while preventing fecal soilage.