Spontaneous Cholecystocutaneous Fistula: A Rare Presentation of Gallstones

Abstract

Spontaneous cholecystocutaneous fistula, one of the rarest complications of acute cholecystitis, has been reported in fewer than 25 cases over the past 50 years. Not only is this case rare but interestingly the patient experienced no pain or symptoms consistent with gallbladder pathology leading up to her hospitalisation. Furthermore, laboratory studies, microbiology and computed tomography scanning did not establish a diagnosis until the fistula passed calculi.An 85-year-old lady with multiple co-morbidities presented to the Emergency Department with an erythematous soft and non-tender mass in her right flank. The mass had spontaneously ruptured and was discharging a serous-like material. Prior to further investigation a working diagnosis of an eroding/fungating caecal tumour was made. The lesion continued to discharge over a 3 month period which heralded the passage of 11 small, brown calculi thought to be gallstones. At this point spontaneous cholecystocutaneous fistula was diagnosed and was later confirmed by magnetic resonance imaging cholangiopancreatography.

Perfoation of the gallbladder: ‘bait’ for the unsuspecting laparoscopic surgeon

“…9 SCF are invariably complications of chronic calculous cholecystitis, though acalculous cholecystitis and carcinoma of the gallbladder have been reported. 10 Incidence of SCF has declined dramatically and they have become one of the rarest complications of gallstone disease. The decreasing incidence is supported by the availability of large series published before 1950: Courvoisier 9 described 169 cases, Naunyn 11 described 184 cases, Bonnet 12 discussed 122 cases, and Henry and Orr 13 detailed 37 cases.…”

“…17,18 Conservative management with ERCP to remove calculi to allow spontaneous closure of the fistula has also been attempted. 10 Cholecystoenteric fistulae (CF) are communications between the gallbladder and gastrointestinal tract. CF are rare complications of chronic calculous cholecystitis, and have been reported in 0.15-5% of patients with biliary disease.…”

Fístula colecistocutánea espontánea en una paciente mayor

“…La fístula colecistocutánea espontánea es una rara complicación de las colecistitis agudas 1 . Su frecuencia es muy baja, dado el diagnóstico y tratamiento precoz de la enfermedad de la vía biliar.…”

Subcutaneous Abscess Secondary to Xanthogranulomatous Cholecystitis

“…12 Treatment of xanthogranulomatous cholecystitis involves cholecystectomy because of the need to discard malignant focus within the lesion, since there is an association with gallbladder carcinoma. 12 The treatment of the complication reported in this case involves the resection of both the communication tract and the gallbladder, 13 and this can be achieved in a single stage procedure 3 or in a two-stage procedure, including broadspectrum antibiotics, drainage of the abscess and elective cholecystectomy with excision of the tract, 14 which was performed. As this condition commonly occurs in elderly and debilitated patients, treatment must be tailored to the patient.…”