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Case Reports
. 2010 Sep 15;4(3):356-360.
doi: 10.1159/000320687.

Spontaneous Cholecystocutaneous Fistula

Raffaele Pezzilli  1 , Bahjat Barakat, Roberto Corinaldesi, Mario Cavazza
Affiliations
Case Reports

Spontaneous Cholecystocutaneous Fistula

Raffaele Pezzilli et al. Case Rep Gastroenterol. .

Abstract

Spontaneous cholecystocutaneous fistula is a rare complication of chronic calculous cholecystitis because currently gallstones are diagnosed and treated at an early stage. This occurrence is possible even if it seems actually to be rare. We report the case of a 90-year-old woman admitted to our hospital with diarrhea of 4 days duration and low-grade fever (37.5°C). On physical examination, she had a 10 × 10 cm erythematous swelling and discomfort of the upper right abdominal quadrant; the skin and mucosae were dry. Transabdominal ultrasonography showed a gallbladder with abnormalities of the wall, a single gallstone impacted in the infundibulum and a fluid collection with irregular margins containing fluctuating echoes adjacent to the anterior abdominal wall of the upper right abdominal quadrant. A diagnosis of spontaneous cholecystocutaneous fistula with an abdominal purulent collection was reached. Due to the high anesthesiological risk of the patient, conservative management was carried out with fluids, broad-spectrum antibiotic, albumin and calcium supplementation. Computed tomography drainage of the purulent collection was also carried out. Both clinical and laboratory parameters substantially improved during the following two days, but on the third day of hospitalization, the patient died from a sudden arrhythmic event.

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Figures

Fig. 1
Fig. 1
Transabdominal ultrasonography. Upper quadrant: gallbladder with abnormalities of the wall, a single gallstone of 2.8 cm of diameter impacted in the infundibulum. Lower quadrant: fluid collection of 6 × 7 cm with irregular margins containing fluctuating echoes adjacent to the anterior abdominal wall of the upper right abdominal quadrant.
Fig. 2
Fig. 2
CT. Upper quadrant: gallbladder with a single gallstone 2.8 cm in diameter impacted in the infundibulum. Lower quadrant: fluid collection of 6 × 7 cm adjacent to the anterior abdominal wall of the upper right abdominal quadrant.
Fig. 3
Fig. 3
Purulent appearance of the abdominal collection.
Fig. 4
Fig. 4
CT drainage of the abdominal fluid collection.
See this image and copyright information in PMC

References

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