• Kasra Shirini Department of general surgery, Iran University of Medical science, Tehran, Iran
  • Hossein Torabi General Surgeon, Department of General Surgery, Poursina Medical and Educational Center,Guilan University of Medical Sciences, Guilan, Iran
  • Rona Ghaffari MD, Gulian University of Medical Science, Iran
  • Dorsa Shirini Cardiovascular research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Siavosh Katebi MD, Department of general surgery, Iran University of Medical Science, Tehran, Iran
Keywords: Cholecystogastric fistula, Cholecystoenteric fistula, Cholecystitis, Bile duct, Abdominal pain


Cholecystogastric fistula is one of the rarest and most life-threatening complications of gallbladder stone disease. This disease can mimic other diseases, such as perforated peptic ulcers, and is too hard to be diagnosed preoperatively. This article presents a patient with cholecystogastric fistula presentation as a peptic ulcer disease. This article presents a 58-year-old man with the presentation of abdominal pain and acute cholecystitis symptoms mimicking perforated peptic ulcer during hospitalization. Clinical examination and imaging confirmed the diagnosis of peptic ulcer disease. Laparotomy revealed that the disease was a simultaneous gallbladder stone disease, which led to acute cholecystitis following cholecystogastric fistula. Cholecystogastric fistula should be considered a significant differential diagnosis in patients with abdominal pain and cholecystitis symptoms.


1. Aamery A, Pujji O, Mirza M: Operative management of cholecystogastric fistula: case report and literature review. J Surg Case Rep. 2019, 4:1-2. DOI:10.1093/jscr/rjz345
2. Massarrat S: Prevalence of gallstone disease in Iran. J Gastroenterol Hepatol. 2001, 16:564-567. DOI:10.1046/j.1440-1746.2001.02478.x
3. Gandhi D, Ojili V, Nepal P, et al.: A pictorial review of gall stones and its associated complications. Clin Imag. 2020, 60:228-236. DOI:10.1016/j.clinimag.2019.11.015
4. Ali MF, Friedel D, Levin G: Two Anomalies in One: A Rare Case of an Intrahepatic Gallbladder with a Cholecystogastric Fistula. Case Rep Gastroenterol. 2017, 21:148-154. DOI:10.1159/000462964
5. Duzgun AP, Ozmen MM, Ozer MV, Coskun F: Internal biliary fistula due to cholelithiasis: a single-centre experience. World J Gastroenterol. 2007, 13:4606-4609. DOI:10.3748/wjg.v13.i34.4606
6. Saeed M, Khan M, Bachan M, Khan Z: Cholecystogastric fistula: a rare complication of cholelithiasis/ascending cholangitis. Chest. 2019, 156:A2039-A2040. DOI:10.1016/j.chest.2019.08.1999
7. Li X, Zhao X, Zheng P, Kao X-M, Xiang X-S, Ji W: Laparoscopic management of cholecystoenteric fistula: A single-center experience. Journal of International Medical Research. 2017, 45:1090-1097. DOI:10.1177/0300060517699038
8. Boland MR, Bass GA, Robertson I, Walsh TN: Cholecystogastric fistula: a brief report and review of the literature. Journal of Surgical Case Reports. 2013, 28:1-3. DOI:10.1093/jscr/rjt028
9. Arioli D, Venturini I, Masetti M, et al.: Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: a new variant of "Bouveret's syndrome". World J Gastroenterol. 2008, 7:125-128. DOI:10.3748/wjg.14.125
10. Tarasconi A, Coccolini F, Biffl WL, et al.: Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg . 2020, 15:2020. DOI:10.1186/s13017-019-0283-9