Incidentally diagnosed coecum cancer during the operation on gallstone – ileus – A case report

Introduction: Cholecystoduodenal fistula is a rare, but dangerous complication of the biliary stone disease. Gallstones can migrate into the bowel via this fistula and can cause ileus, typically at the level of terminal ileum.

Patients: A 79 years old female was admitted to our hospital because of upper gastrointestinal bleeding. She had suffered from significant cardiovascular diseases. Two years ago she developed obstructive jaundice which was resolved by endoscopic papillotomy and stone extraction. Subsequent cholecystectomy was not performed considering her cardiovascular state. At present admission urgent gastroscopy revealed a duodenal ulcer. During 1-day observation small bowel ileus developed with pneumocholangiogram. At the operation not only a large gallstone was found at the terminal ileum, but a 6cm malignant cancer was also revealed in the coecum. The patient had no complaints concerning bowel habits or anemia. A right hemicolectomy, resection of terminal ileum, cholecystectomy and the closure of the duodenal fistula were performed at the same session. The recovery of the patient was fast and she was discharged from the hospital on the 14th day. In summary: To assess the risk of operation is not easy in some cases. A simple cholecystectomy was denied 2 years ago in fear of high risk of operation. A significantly larger, urgently performed operation could be performed safely 2 years later. On the other side laparoscopic cholecystectomy 2 years earlier could miss the tumor in the coecum which was presumably present at that time.