The cholecystocolonic fistula (CCF) is an atypical variant of biliary disease, and it is the second most common intestinal fistula after cholecystoduodenal fistula. Intraoperative diagnosis is frequent, which implies challenging surgical management, especially in patients, often aged, with comorbidities. The rarity of this condition, atypical and various presentation, diagnostic and management complexity, makes it a unique surgical entity. We report our experience of an 84-year-old man with a history of chronic cholecystitis who presented with nonspecific symptoms. The imaging tests aroused the suspicion of gallbladder-colic fistula in the preoperative diagnosis, facilitating the subsequent surgical treatment that confirmed the diagnosis.

Background and Objectives: Progressive pulmonary fibrosis (PPF) presents significant clinical challenges due to irreversible lung damage and declining respiratory function. Nintedanib has demonstrated antifibrotic effects, yet there is a lack of sensitive tools to assess treatment efficacy quantitatively. This study evaluated the potential of artificial intelligence (AI)-powered quantitative computed tomography (QCT) to monitor lung changes and predict treatment outcomes in patients with PPF undergoing nintedanib therapy. Materials and Methods: This retrospective study analysed 37 patients diagnosed with PPF who were treated with nintedanib for one year. AI-powered QCT was performed using the 3D Slicer software version 5.2.2, which quantified lung infiltration, collapse, and vessel volumes. These data were then correlated with pulmonary function tests. Receiver operating characteristic (ROC) analysis was used to assess baseline AI-powered QCT predictors for progression. Results: AI-powered QCT demonstrated a significant reduction in post-treatment right lung infiltration (5.56 ± 3.08 cm³ to 4.88 ± 2.77 cm³, p = 0.041), whereas total lung infiltration decreased non-significantly. Functional parameters, including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO), showed no significant changes. ROC analysis identified a baseline infiltrated lung volume greater than 21.90% as predictive of continued disease progression (AUC = 0.767; sensitivity, 91.70%; specificity, 68.00%). Conclusions: AI-powered QCT identified diverse parenchymal responses to nintedanib in PPF and showed preliminary prognostic value for clinical trajectory. Imaging biomarkers enhance functional measures and may reveal early treatment effects. Prospective, multicentre validation is necessary to confirm usefulness and establish actionable thresholds for clinical application.

Background: Percutaneous transhepatic biliary drainage (PTBD) remains a cornerstone in managing obstructive jaundice, particularly when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or contraindicated. This study aims to compare ultrasound-guided (US-PTBD) and fluoroscopy-guided (F-PTBD) techniques regarding procedural time, radiation exposure, technical success, and complication rates. Methods: This retrospective, single-center study included patients with malignant obstructive jaundice who underwent PTBD between January 2018 and December 2025. Patients were stratified based on the imaging modality used for the bile duct puncture (US-PTBD vs. F-PTBD). Procedural characteristics, including dose–area product (DAP), fluoroscopy time, complication rates, and technical success, were analyzed using statistical methods appropriate for continuous and categorical data. Results: A total of 133 patients (163 PTBD procedures) were included. US-PTBD demonstrated significantly lower DAP (4.1 ± 1.9 Gy·cm² vs. 6.2 ± 1.5 Gy·cm²; p < 0.001) and shorter procedure time (42 ± 7 min vs. 56.6 ± 6 min; p < 0.001) compared to F-PTBD. Both techniques had comparable technical success rates (91.1% vs. 82.2%; p = 0.158). Complications occurred in 10.2% of patients in the F-PTBD group and 6.7% in the US-PTBD group, with no statistically significant difference between groups (p = 0.489). Major complications, including bleeding and cholangitis, occurred exclusively in the F-PTBD cohort. US-PTBD resulted in fewer Glisson capsule punctures, suggesting reduced procedural trauma. Conclusions: Although a significant access side imbalance was present between cohorts, US-PTBD offers distinct advantages over F-PTBD, including reduced radiation exposure, shorter procedure times, and a comparable safety profile. These findings highlight the potential of US guidance as a safer alternative for PTBD, particularly in patients with coagulopathy or complex anatomy. Further multicenter studies with larger populations are warranted to confirm these benefits and refine patient selection criteria.

Background/Objectives: Percutaneous transhepatic biliary drainage (PTBD) remains a cornerstone in managing obstructive jaundice, particularly when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or contraindicated. This study aims to compare ultrasound-guided (US-PTBD) and fluoroscopy-guided (F-PTBD) techniques regarding procedural time, radiation exposure, technical success, and complication rates. Methods: This retrospective, single-center study included 133 patients (163 PTBD procedures) with malignant obstructive jaundice who underwent PTBD between January 2018 and December 2024. Patients were stratified based on the guidance method (US-PTBD vs. F-PTBD). Procedural characteristics, including dose-area product (DAP), fluoroscopy time, complication rates, and technical success, were analyzed using statistical methods appropriate for continuous and categorical data. The study protocol was approved by the local Ethics Committee. Results: US-PTBD demonstrated significantly lower DAP (4.1 ± 1.9 Gy·cm² vs. 6.2 ± 1.5 Gy·cm²; p < 0.001) and shorter procedure time (42 ± 7 minutes vs. 56.6 ± 6 minutes; p < 0.001) compared to F-PTBD. Both techniques had comparable technical success rates (91.1% vs. 82.2%; p = 0.158). Complication rates were higher in the F-PTBD group (10.2% vs. 6.7%), with major complications, including bleeding and cholangitis, occurring exclusively in the F-PTBD cohort. US-PTBD resulted in fewer Glisson capsule punctures, suggesting reduced procedural trauma. Conclusions: US-PTBD offers distinct advantages over F-PTBD, including reduced radiation exposure, shorter procedure times, and a comparable safety profile. These findings highlight the potential of US guidance as a safer alternative for PTBD, particularly in patients with coagulopathy or complex anatomy. Further multicenter studies with larger populations are warranted to confirm these benefits and refine patient selection criteria.