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Spontaneous entero-biliary fistula
2 Endoscopy 4 ERCP 1 Clinical case E Gallbladder and Biliary tree 6 Radiology bruno giovanni, entero-biliary fistula, fistola entero-biliare, coledocolitiasi, choledocholithiasis
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Author: BRUNO Giovanni, Rome, Italy
A 41-year-old male was admitted to the Emergency Department with abdominal pain and jaundice. His medical history includes multiple comorbidities: antiphospholipid antibody syndrome with secondary glomerulonephritis, chronic kidney disease undergoing dialysis (left upper limb AVF thrombosed in 2024), autoimmune thrombocytopenia (platelet count approximately 14,000), severe mitral insufficiency following endocarditis (mitral valve replacement complicated by sepsis), and a previous cerebral hemorrhage.
A CT scan revealed acute cholecystitis and aerobilia, with suspicion of an entero-biliary fistula. This suspicion was confirmed by cholangio-MRI.
Subsequently, a duodenoscopy was performed, confirming the presence of the fistula and the spontaneous passage of the gallstone.
MRI and CT sequences available on YouTube: https://youtu.be/r1a6Vvtia4M
Conclusion: "Nature repairs everything." – Montesquieu
