A rare complication of gallstones ended with spontaneous cholecystocutaneus fistula in an old man: A case report

Abstract

Introduction: Cholecystocutaneous fistula is an extremely rare complication of gallstones. The majority of the fistulae localize into the right upper quadrant of the abdomen. Diagnosis is not easy because the symptoms are nonspecific. External biliary fistula is more common in females between the 5th-7th decades because in this age group the frequency of cholecystitis is increased.

Case presentation: A 65-year-old man presented with a swelling in the right hypochondrium. He had not complained of any serious symptoms. Laboratory investigations were normal. Both abdominal ultrasound and Multislice computed tomography (MSCT) showed that the gallbladder contained stones, in addition to a cystic mass in the abdominal wall. The previous findings suggested that there was an abscess. So, the patient underwent laparoscopic procedure, and we found a fistula between the gallbladder and the abdominal wall causing the abscess. The greater omentum was adherent to the inflamed gallbladder. So that we transformed into open procedure to perform cholecystectomy and resect the fistula.

Discussion: Biliary fistulae have two types, external and internal. The most common type is internal. External biliary fistulae emerge like a complication of cholecystolithiasis in general. Spontaneous cholecystocutaneous fistulae occur due to acute inflammation caused by cholecystitis or chronic gallstones disease. The most common clinical manifestation is an abscess in the abdominal wall that discharges bile to the outside.

Conclusion: Computed tomography is considered the gold standard in diagnosing a spontaneous cholecystocutaneous fistula, and it should be considered as a differential diagnosis for any abscess that is evident in the abdominal wall.

Keywords: Abscess; Cholecystocutaneous; Cholelithiasis; Fistula; Gallstone; Spontaneous fistula.