PMC9972505_01
Clinical data of the patient with biliary-colonic fistula. (A) Abdominal computed tomography (CT) showed residual gallbladder neck-duct stone (yellow arrow). (B) Endoscopic retrograde cholangiopancreatography (ERCP) identified choledocholithiasis (yellow arrow). (C) Gallbladder neck-duct stone as seen using the Choledochoscope System. (D) Fluoroscopic image of the guide wire entering the intestinal cavity. (E) The Choledochoscope System enters the intestinal cavity through the sinus tract. (F) Colonic mucosa as seen using the Choledochoscope System. (G) In the second operation, co-use of duodenoscopy and colonoscopy was used. ERCP showed the reflux substance in the bile duct as the guide wire entered the cavity. (H) Guide wire and fistula of colonic hepatic flexure as seen under colonoscopy. (I) Dye injected into the bile duct flowing out from the colonic fistula. (J) Titanium clips were used to clamp the colonic fistula. (K) Fluoroscopic image of the placed biliary stent after recleaning the bile duct. (L) CT examination to confirm biliary stent position.
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Abdominal computed tomography (CT) showed a large number of stones in the common bile duct and cystic duct (Figure 1A). We conducted ERCP and used the eyeMax Choledochoscope System Digital Controller (MICRO-TECH, Nanjing, China) to explore the bile duct (Figure 1B and C). However, fluoroscopy showed an unusual shadow of the intestine (Figure 1D), which attracted our attention. Choledochoscope System and identified a sinus tract. Clear colonic mucosa of the intestine could be seen after moving forward (Figure 1E and F). In the second operation (Figure 1G), the duodenoscope guide wire entered the intestine via the cystic duct and the colonoscope entered through the hepatic flexure of the colon. The guide wire, colon fistula, and dye outflow from the colon fistula were all observed (Figure 1H and I). Eight titanium clips were used to clamp the colon fistula, which blocked the outflow of dye after reinjection (Figure 1J). A 10-mm-diameter and 8-cm-long fully covered self-expandable metal stent (SEMS) was placed through the duodenoscope to compress the cystic duct after the bile duct was cleared with a balloon (Figure 1K). The patient had no post-operative complications and CT reexamination confirmed proper stent positioning (Figure 1L), and the patient's clinical condition was stable without symptoms at a 3-month follow-up.