Xanthogranulomatous cholecystitis complicated by a cholecysto-colonic fistula and liver abscesses

A 57-year-old male presented to the emergency department with right upper quadrant pain and constitutional symptoms. Initial investigation revealed biliary sepsis with features of chronic cholecystitis, multiple liver abscesses and a fistulous connection between the gallbladder and colon. He was subsequently diagnosed with a cholecysto-colonic fistula, an unusual complication of biliary pathology, with an incidence of 0.06–0.14% at cholecystectomy. It is the second most common form of cholecystoenteric fistula, the first of which is cholecystoduodenal. A preoperative diagnosis was suggested using computed tomography and sinogram imaging. The associated liver abscesses together with the xanthogranulomatous inflammation found on histopathology, makes the case particularly exceptional.