Cholecystocolonic Fistula with Malabsorption

Publisher Website
Google Scholar
Abstract
An 80 year old white woman complained of weakness and diarrhea. Though the past history and physical examination revealed no indication of gallbladder disease, a barium enema clearly demonstrated a cholecystocolonic fistula. In addition, the patient was found to have malabsorption of fat, carotene, calcium and d-xylose, together with hypokalemia and hypoprothrombinemia. The hypokalemia and hypoprothrombinemia were corrected by parenteral administration of potassium and vitamin K. No bile was found on duodenal aspiration and the cholecystocolonic fistula had produced a situation in which bile, though present in the stools, was not available for absorption in the small bowel. Therefore, oral bile salts were administered, and the malabsorption of carotene, calcium, fat and d-xylose was corrected, with improvement in the patient''s symptoms. The clinical syndrome of cholecystocolonic fistula is reviewed. The importance of bile salts for the absorption of fat, carotene, and vitamin D is discussed. No satisfactory explanation could be found for the improvement of d-xylose absorption, and further confirmation that absence of bile may lead to impaired d-xylose absorption is sought.