General NM case of the month (06/09): Cholecysto-colonic fistula
This case was compiled by Dr. David He, BCM
72yrs old male was referred for hepatobiliary scintigraphy because of
complaints of right upper quadrant abdominal pain, made worse by
defecation. Dynamic 1 min/ frame images of the abdomen were acquired in
anterior projection after intravenous administration of 6.7 mCi of Tc-99m
labeled mebrofenin (Choletec).
complaints of right upper quadrant abdominal pain, made worse by
defecation. Dynamic 1 min/ frame images of the abdomen were acquired in
anterior projection after intravenous administration of 6.7 mCi of Tc-99m
labeled mebrofenin (Choletec).
The images show good uptake by the liver suggesting adequate hepatocellular
function. Activity is seen entering the common bile duct and the gall bladder,
excluding cystic duct obstruction/ acute cholecystitis. Towards the end of 1 hr
of imaging, the gall bladder activity is seen to move in the pattern of transverse
colon and abrupt cutoff is seen in the common bile duct, without any small
bowel activity. These findings suggest cholecysto-colonic fistula and partial
common bile duct obstruction.
function. Activity is seen entering the common bile duct and the gall bladder,
excluding cystic duct obstruction/ acute cholecystitis. Towards the end of 1 hr
of imaging, the gall bladder activity is seen to move in the pattern of transverse
colon and abrupt cutoff is seen in the common bile duct, without any small
bowel activity. These findings suggest cholecysto-colonic fistula and partial
common bile duct obstruction.
Cholecysto-colonic fistula was confirmed on barium enema. Supporting
findings seen on the CT scan included the presence of air in the gall bladder
and loss of fat plane between the gall bladder and the hepatic flexure of colon.
Sphinterotomy was done on the follow up ERCP and multiple large stones
were removed from the CBD.
findings seen on the CT scan included the presence of air in the gall bladder
and loss of fat plane between the gall bladder and the hepatic flexure of colon.
Sphinterotomy was done on the follow up ERCP and multiple large stones
were removed from the CBD.
