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General Surgery

A Rare Case of Abdominal Wall Abscess containing a Gallstone Secondary to Cholecystocutaneous Fistula

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Introduction/Purpose: A cholecystocutaneous fistula is an abnormal epithelial tract that allows communication between the gallbladder and the skin.  In some cases the communication is spontaneous due secondary to iatrogenic causes. Spontaneous cholecystocutaneous fistula is a rare condition.

Methods or Case Description: A 71-year-old female presented to ED with history of right sided abdominal wall mass with associated abdominal pain. She presented mass in right hypogastrium, tender, erythematous, warm and no drainage. Next we underwent incision and drainage of right abdominal wall abscess.

Outcomes: On postoperatively day 3, patient had penrose removed without complications.  Pathology revealed bile pigmented crystallin structure with surface acute inflammatory cells suggestive of biliary calculus. Patient informed of pathology results and instructed to have a HIDA scan to evaluate gallbladder morphology and function if possible repeat of CT.

Conclusion: Cholecystocuteanous fistulas are increasingly rare.  In spontaneous cholecystocutaneous fistula, the abscess is walled off by the abdominal wall and eventually it progressively penetrates its. The fistula usually occurs via fundus of the gallbladder and in this case has not progressed enough for fistula to have drainage onto the skin. With the increase in surgical treatment of gallbladder calculus disease the incidence of cholecystocutanous fistula has fallen dramatically .  A literature review of case published between 1961 and 2013 identified 50 cases. While external biliary fistula is rare and can be a post-operative complication of liver and biliary tract surgery, they can also be traumatic, therapeutic, spontaneous. While cholecystocutaneous fistula is rare occurrence, we can consider this as a rare complication of gallbladder disease.