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

Abstract

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.

Spontaneous cholecystocutaneous fistula secondary to xanthogranulomatous cholecystitis: a case report

“…However, the outcomes of such approaches remain unclear. Several studies recommend an open approach, considering its feasibility and lower complication rates [ 7 , 8 ]. We are in agreement with this strategy and concur that laparoscopic surgery performed by surgeons with the required expertise may be a feasible approach for effective management of CCF in select patients and offers the known advantages of laparoscopic surgery.…”

The Cholecystocutaneous Fistula: A Rare Manifestation of Neglected Cholecystitis

“…For stable patients who may present with relatively few symptoms other than an abscess or draining fistula tract, a single stage definitive operation with external drainage and open cholecystectomy has been considered the treatment of choice [1,7,10]. A laparoscopic approach to this single-stage operation has been reported with success by several authors, though generally this is reserved for patients who have a more subacute presentation [11][12][13]. In patients too frail or unstable to tolerate an operation, treatment with antibiotics, supportive care, and source control with bedside incision and drainage, percutaneous removal of stones and biliary decompression by ERCP, or CT-guided drain placement have been advocated [5,14,15].…”

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

“…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] ].…”

“…CT confirmed the diagnosis by identifying the track between the gallbladder and the skin in several cases [ [22] , [23] , [24] , [25] ]. Furthermore, CT fistulogram can also show the track of CCF which confirm the diagnosis [ 21 ]. CT couldn't identify the track of CCF in a few cases where it just showed abnormal findings which point toward the diagnosis [ [19] , [23] , [26] , [27] ].…”

“…CT Fistulogram or X-ray Fistulogram have been used to demonstrate track of the fistula accurately [ [14] , [21] , [30] ], although in most cases Fistulogram was not used and the diagnose was made by another method.…”