Massive lower gastrointestinal hemorrhage from cholecystocolic fistula

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Abstract
Summary and Conclusions A case of spontaneous internal biliary fistula involving the gallbladder and colon has been presented. Unusual features included massive bleeding from the rectum due to erosion of the cystic artery and the presence of a granulomatous mass in the colon adjacent to the fistula. Treatment consisted of ligation of the bleeding artery, tube cholecystostomy and removal of the involved segment of colon, which resulted in a fecal fistula which closed spontaneously. Subsequently the patient recovered fully. Massive bleeding of unknown origin from the rectum should arouse suspicion of biliary tract disease. Gastrointestinal bleeding manifested as melena is uncommon in cholecystoenteric fistulas.

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