Combination of External Biliary and Cholecystoduodenal Fistula in an Obese Patient

Abstract

Nazarbek Omarov, Meyrbek Aimagambetov, Medet Auenov, Samatbek Abdrakhmanov, Tolkyn Bulegenov, Yoshihiro Noso, Erlan Asylbekov

The attention of surgeons is actively growing on the matter of improving treatment outcomes in patients with acute calculous cholecystitis with concomitant overweight and obesity. Research objective is to share the experience of treating one case of a combination of an external biliary fistula with cholecystoduodenal fistula in an obese patient using our treatment method. A rare occurrence of acute destructive cholecystitis complicated by phlegmon of the anterior abdominal wall, with the formation of an external bile fistula with cholecystoduodenal fistula in a patient with concomitant obesity. We want to submit this case as a very rare complication of acute destructive calculous cholecystitis. The results of surgical treatment of 3,957 patients with cholelithiasis among those treated at the Semey State Medical University, Semey were analyzed from January 2011 until September 2018. The phased surgical treatment of the patient was carried out. The first stage of the patient is the calculi removal with the evacuation of purulent bile and the cholecystostomy setting. The second stage was performed using the Aimagambetov universal retractor device for clients with overweight and obesity after 6 days developed in the clinic, and performed the Method of dissociation of cholecystoduodenal fistula with subsequent cholecystectomy in obese patients from the mini-approach. Two-stage surgical treatment and the use of the “Method for disconnection of cholecystoduodenal fistula with subsequent cholecystectomy in obese patients from the mini-approach” developed in the clinic is the best way out in this case.