Case Report: Spontaneous cholecystocutaneous fistula, a rare cholethiasis complication

Rinzivillo, Nunzio Maria Angelo; Danna, Riccardo; Leanza, Vito; Lodato, Melissa; Marchese, Salvatore; Burzotta, Francesco; Zanghì, G

doi:10.12688/f1000research.12235.1

Cited by 17 publications

(14 citation statements)

References 40 publications

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“…US provides good assessment for CCF diagnosis by showing abnormal findings such as abscess, gallbladder stones, edema, thickened in gallbladder wall and dilated biliary ducts [ [5] , [15] , [17] , [21] ] but often fails to confirm the CCF diagnosis. In a few cases, US was able to demonstrate the track of CCF [ [12] , [19] ].…”

Section: Methodsmentioning

confidence: 99%

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

Alsaman

Mazketly

Ziadeh

et al. 2020

Annals of Medicine and Surgery

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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.

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Section: Methodsmentioning

confidence: 99%

“…MRI was able to detect gallstones, gallbladder perforation, and the fluid, which extruded through the abdominal wall [ [5] , [18] ].…”

Section: Methodsmentioning

confidence: 99%

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

Alsaman

Mazketly

Ziadeh

et al. 2020

Annals of Medicine and Surgery

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“…A cholecystocutaneous fistula (CCF) connects the gallbladder to the skin, and is a form of EBF that has been reported with less frequency in the last century due to improving medical diagnostic techniques and identification. A total of 169 cases were reported by Courvoisier in the 19th century [7-8]. From 1900 to 1991, there were only a reported 65 cases of EBF in the literature [4,9-10].…”

Section: Introductionmentioning

confidence: 99%

Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract

Lofgren

Vasani

Singzon

2019

Cureus

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Cholecystocutaneous fistulas (CCFs) are an increasingly rare consequence of chronic gallbladder inflammation and disease. Historically, they were commonly noted in the literature by Courvoisier, Naunyn, and Bonnet in the late 1800s. Due to improvements in diagnostic imaging and treatment options in the last century, there has been a marked decrease in the incidence of the CCF cases in the literature. From the late 1890s to 1949, there were only 37 cases presented in the literature; only 28 cases have been reported since 2007. This case is only the second noted CCF in the literature that followed percutaneous cholecystostomy drain placement and removal. General surgery was consulted on a 60-year-old morbidly obese female, who presented to the emergency department after one week of fever, right upper quadrant (RUQ) pain, nausea, emesis, and shortness of breath. She had a history of acute cholecystitis treated with a cholecystostomy tube the year prior, but after the removal of the tube, she was lost to follow up. She was found to have a 14cm x 5cm fluctuant abdominal wall abscess in her RUQ that was treated with incision and drainage (I&D) along with ertapenem. She continued to improve until day 7 post-I&D when yellowish-green discharge was noted draining from the wound. After a negative hepatobiliary iminodiacetic acid scan, a follow-up abdominal computed tomography (CT) showed a contracted gallbladder with fistula formation underlying the abscess location, near the site of her prior cholecystostomy tube. A robotic-assisted cholecystectomy was performed, which improved the wound drainage, and the patient was discharged home 5 days later. This case is the only noted CCF presenting as a RUQ abscess after cholecystostomy drain placement. The patient lacks follow up after the removal of her percutaneous drain and continued inflammation in the gallbladder provided perfect nidus for the fistula formation. As seen in other CCF patients, cholecystectomy is the treatment of choice, and this case was successfully treated via robotic-assisted cholecystectomy with adhesiolysis.

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“…Biliary fistulas are usually a complication of acute calculous cholecystitis and can be either internal or external 1. Internal fistulae are more common than external fistulae.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous cholecystocutaneous fistula: empirically treated for a missed diagnosis, managed by laparoscopy

et al. 2019

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A 70-year-old woman was referred to our hospital from primary health centre with complaints of pain in the abdomen, swelling and discharging sinus in the right hypochondrium since 2 years. She had received anti-tubercular treatment for 18 months as the wedge biopsy of the sinus tract suggested granulomatous lesion. As the symptoms did not subside she was referred to our hospital. Her blood investigation reports at our hospital were normal. Ultrasound of the abdomen suggested cholelithiasis with normal common bile duct. CT fistulogram findings were diagnostic of cholecystocutaneous fistula (CCCF). She underwent laparoscopic cholecystectomy and excision of the sinus tract. Postoperative recovery was uneventful. Indiscriminate usage of anti-tubercular drugs should be discouraged and possibility of CCCF should be considered in patients presenting with discharging sinus in the anterior abdominal wall. CT fistulogram is helpful in making diagnosis of CCCF. Cholecystectomy with excision of the sinus tract is the treatment of choice.

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Case Report: Spontaneous cholecystocutaneous fistula, a rare cholethiasis complication

Cited by 17 publications

References 40 publications

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

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

Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract

Spontaneous cholecystocutaneous fistula: empirically treated for a missed diagnosis, managed by laparoscopy

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