[Cholecystocutaneous fistula as a first sign of presentation of a gallbladder adenocarcinoma]

Cholecystocutaneous fistula incidence, Etiology, Clinical Manifestations, Diagnosis and treatment. A literature review

Cholecystocutaneous Fistula (CCF) is a type of external biliary fistula, which connects the gallbladder with the skin. Thilesus first described this phenomenon in 1670. There is usually a history of calculi in the gallbladder or neglected gallbladder disease. The incidence of CCF is rare, most patients are elderly females with the mean age of 72.8 years old. They usually present with chronic calculus cholecystitis or a history of a previous surgical intervention. US, CT, MRI, MRCP and (CT or X-ray) fistulogram are used to confirm the diagnosis. CT was more significant than US in identifying the track of the fistula and the fluid that runs throw it. CCF patients presented with systemic symptoms (fever, nausea and vomiting) or local symptoms. RUQ region is the most common site of external opening. Open cholecystectomy with excision of the fistulous tract is considered an acceptable option for treatment and it is curative in most cases. However, laparoscopic approach can be another option with experience surgeons.

Case Report: Spontaneous cholecystocutaneous fistula, a rare cholethiasis complication

One of the most unusual complications in cholethiasis is spontaneous cholecystocutaneous fistula, which has only been reported a few times in the literature.  We report the case of a 76 year old man who presented with a right hypochondrium subcutaneous abscess, with pain evoked through palpation.  No comorbidity in the patient’s medical history were noted.   Confirmation of cholecystocutaneous fistula was made using the proper diagnostic process, which is computed tomography with contrast media, followed by hepatobiliary MRI. This confirmed the presence of a fistulous pathway between the gallbladder and the skin.  The patient underwent cholecystectomy surgery and open laparotomy with en block aponeurotic muscle, skin and fistula orifice excision.

[Spontaneous cholecystocutaneous fistula]

BACKGROUND

Spontaneous cholecystocutaneous fistula is defined as a gallbladder communication with the external environment through the abdominal wall rupture; the first reports were written in the seventeenth century by Thilesus. During the past 50 years 25 cases have been reported.

CLINICAL CASE

We report a case of a 30-year-old woman presented with a five-year history of biliary colic, six months prior to medical assessment presents outlet of biliary material and gallstones spontaneously in the right upper quadrant. Fistulogram was performed without evidence of obstruction, subsequently cholecystectomy and resection of the fistula was performed.

DISCUSSION

The biliary fistulas are an abnormal communication from the gallbladder into another surface, is a rare condition in our day as it only occurs in 10% of patients with gallbladder lithiasis; while spontaneous cholecystocutaneous fistula clinic is more than evident. It is imperative perform studies like ultrasound, tomography, and fistulogram. The mainstay of treatment is cholecystectomy, resection of the fistula and repair of abdominal wall defect.

CONCLUSION

The incidence of cholecystocutaneous fistula today is minimal and it seems that the current trend is to become an entity anecdotal, the approach subcostal abdominal examination remains as the first choice. The laparoscopic approach is an option reserved for the experienced surgeon.