Enterocutaneous fistula 3 years after resection of an advanced gallbladder carcinoma

Abstract

A 71-year-old woman presented to the emergency department with abdominal pain and fever. Her surgical history was significant for gallbladder adenocarcinoma for which she had undergone extensive resection 32 months previously. At that time she underwent cholecystectomy, wedge resection of the liver, pancreatoduodenectomy, right nephrectomy and right hemicolectomy for a locally advanced gallbladder adenocarcinoma. Examination revealed a tender, warm, upper midline abdominal wall mass. A CT scan with oral contrast revealed a fistulous tract extending from the gastrojejunostomy (GJ) into an abscess cavity in the adjacent anterior abdominal wall. She underwent open wound drainage with debridement, and was started on parenteral nutrition and intravenous antibiotics. The patient then underwent surgical repair excision of the fistula and refashioning of the GJ 1 month later. Histological examination of the specimen revealed well-healed suture lines, and no evidence of tumour recurrence.

Figure 1

Pre-resection abdominal CT scan showing the gallbladder tumour invading multiple abdominal viscera (A, axial view; B, coronal view).

Figure 2 Abdominal CT

scan showing enterocutaneous fistulae arising from the gastrojejunostomy with anterior abdominal wall collection (A, axial view; B, sagittal view).