Presentation
2 months history of painful cutaneous swelling in the right flank with drainage for the past two weeks. Past history of heart disease and cholelithiasis.
Patient Data
The gallbladder is normal in size, containing small calculi with the thick and enhanced wall. A wall defect is seen at the fundus of the gallbladder, communicating with the abdominal wall through an enhancing fistulous track.
Mild bilateral pleural effusion.
Small paraduodenal diverticulum and renal cysts are noted.
Case Discussion
Case of cholecystocutaneous fistula complicating calculous cholecystitis in a patient with no past history of surgery.
The patient mentioned that she has small stones coming out from this fistula, According to patient's family, she had an abdominal ultrasound 23 years ago which showed cholelithiasis but the patient refused the surgery at that time.
External biliary fistulas are extremely rare, only few cases were reported in the literature and usually are the result of neglected cholelithiasis (as in this case). Other causes include gallbladder neoplasms and post surgical complications (such as percutaneous cholecystostomy).
Treatment includes cholecystectomy, resection of the fistulous track, and repair of abdominal wall defect.
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