Fine needle aspiration cytology (FNAC) was undertaken and revealed high grade adenocarcinoma. The patient underwent an abdominal ultrasonography which showed gallbladder fossa mass infiltrating the portahepatis with proximal biliary dilatation. On examination there was severe jaundice and a lump in the right hypochondrium. We discuss the case of a 48-year-old woman who presented with right hypochondrial pain, jaundice and melena. Multidetector computed tomography (MDCT) can demonstrate the fistulous communication and anatomical details in all three planes. Barium studies of the gastrointestinal tract and colon are diagnostic. Patients may present with non-specific symptoms such as diarrhea, malena and loss of weight. Variations in the incidence of various populations might be partly determined by dietary variations. The ecological evidence indicates considerable geographic variation in the incidence of GBC. Worldwide epidemiological studies have implicated dietary factors in the development of GBC. Aggressive gallbladder carcinomas (GBCs) rarely invade into the adjacent duodenum and/or colon resulting in internal biliary fistula. Among the different types of cholecystoenteric fistulas, the cholecystoduodenal is the most common with cholecystocolonic fistulas being the second most common. The cholecystocolonic fistula is an uncommon but pertinent complication of gallbladder disease, occurring in 0.06 to 0.14% of patients with biliary disease.
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