Background: Although multiple biliary fistulae are not uncommonly encountered in clinical practice, we describe a case of cholecystoduodenocolic fistula which is very rare and limited to case reports.
Case report: A 78 year old female was admitted with a one week history of vomiting, abdominal pain and
watery diarrhea. He appeared unwell, with dry coated tongue, pale conjunctivae and tenderness in
epigastrium. CT abdomen showed a gallstone with dilated common bile duct and air in the biliary
tree. There were features of acute cholecystitis and the possibility of a fistulous communication
between gallbladder was raised. He failed conservative management and on laparotomy was
found to have a cholecystoduodenocolic fistula. He had a successful one stage procedure of
cholecystectomy with fistula repair.
Conclusions: Fistula between the gallbladder and the bowel should be suspected if air in the biliary tree is observed in patients with acute calculus cholecystitis. In our case cholecystoduodenocolic fistula was confirmed on laparotomy.

Keywords: Cholecystoduodenocolic fistula, Cholecystitis, Cholelithiasis