Cholecystogastric fistula presenting with transient gallstone ileus and incidental Fitz–Hugh–Curtis syndrome: A rare radiological and intraoperative association

Abstract

Cholecystogastric fistula (CGF) is the rarest subtype of cholecystoenteric fistula and is an uncommon complication of chronic gallstone disease. Diagnosis is often challenging because of nonspecific clinical features and subtle imaging findings. We report a rare case of CGF presenting with transient gallstone ileus and an incidental intraoperative finding of Fitz–Hugh–Curtis syndrome, a previously unreported association. A 42-year-old woman presented with acute epigastric pain and vomiting on a background of intermittent chronic epigastric discomfort. Contrast-enhanced computed tomography demonstrated an 18-mm lamellated gallstone within the distal ileum with mild proximal small bowel dilatation, suspicious for early gallstone ileus, together with features of chronic cholecystitis. Magnetic resonance cholangiopancreatography subsequently identified a 6mm fistulous tract between the gallbladder and gastric antrum, confirming a cholecystogastric fistula. Diagnostic laparoscopy confirmed the fistula, while no obstructing gallstone was identified, suggesting spontaneous passage into the colon. Characteristic perihepatic “violin-string” adhesions and pelvic adhesions consistent with Fitz–Hugh–Curtis syndrome were incidentally identified intraoperatively. The patient recovered uneventfully and was discharged on postoperative day 1. This case highlights the complementary roles of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing cholecystogastric fistula, with CT identifying indirect features of gallstone ileus and MRCP clearly delineating the fistulous communication. Recognition of transient gallstone ileus and awareness of the potential coexistence of Fitz–Hugh–Curtis syndrome may facilitate diagnosis, operative planning, and interpretation of complex hepatobiliary anatomy. To our knowledge, this represents the first reported association between cholecystogastric fistula and Fitz–Hugh–Curtis syndrome.