Unusual aetiology of abdominal wall abscess: cholecystocutaneous fistula presenting 20 years after open subtotal cholecystectomy

Spontaneous cholecystocutaneous fistula: an uncommon complication of acute cholecystitis

A 78-year-old man presented to the hospital with acute right upper quadrant pain, fever and nausea. A focused abdominal ultrasound and abdominal CT scan were performed demonstrating an acute calculous cholecystitis with gallbladder perforation. Although a CT-guided cholecystostomy was performed and a pericholecystic abscess was relieved promptly, the patient developed a cholecystocutaneous fistula in the right hypochondriac region. A cholecystocutaneous fistula is an extremely rare complication that may occur in patients with acute calculous or acalculous cholecystitis, chronic gallstone disease, gallbladder carcinoma or prior hepatobiliary surgery.

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.

Spontaneous Cholecystocutaneous Fistula: A rare clinical Entity

INTRODUCTION

Spontaneous Cholecystocutaneous Fistula occurs as a result of complication from untreated gall bladder stone disease infrequently seen in surgical practice due to early diagnosis of gall stone disease with imaging and appropriate and prompt antibiotic and surgical treatment.

CASE REPORT

We report our experience with a 40-year-old woman who presented with a yellowish discharge from the umbilicus. Abdominal examination revealed a sinus opening at the umbilicus with the yellowish discharge and a vague mass in the right hypochondrium. CT fistulogram showed tract extending form the umbilicus to the gall bladder. Open cholecystectomy with excision of the fistulous tract was carried out. Histopathological examination showed chronic inflammation of the gall bladder with the fistulous tract lined by inflammatory granulation tissue. Post-operative recovery was normal and uneventful. The patient was normal in follow-up. Cholecystocutaneous fistula is a rare clinical entity. The diagnosis is established with CT and MRCP. Surgery remains the mainstay of treatment.

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.