Cholecystocutaneous Fistula Associated with Edwardsiella tarda as a Result of Aggressive Lymphoma Development.

A cholecystocutaneous fistula is a type of external biliary fistula that occurs when there is an abnormal connection between the gallbladder and skin. We report the first case of a cholecystocutaneous fistula that occurred in association with the development of lymphoma in the gallbladder. A 76-year-old woman who was under observation for follicular lymphoma with a low tumor burden presented with fatigue and abdominal pain. Imaging studies revealed cholecystitis associated with an abdominal subcutaneous abscess, and lymphoma transformation was confirmed by a lymph node biopsy. Edwardsiella tarda was cultured from both the abdominal subcutaneous abscess and percutaneous transhepatic gallbladder drainage, demonstrating cholecystocutaneous fistula, and open cholecystectomy revealed lymphoma cell infiltration into the gallbladder. Our case showed unique complications, and its successful management was associated with aggressive lymphoma development.

Management of a complex cholecystocutaneous fistula with laparoscopic retrieval of gallstones embedded in the abdominal wall.

Cholecystocutaneous fistula is a rare surgical entity caused by an abnormal connection between the gallbladder epithelium and the skin. These complex cases have historically required an open surgical approach and are difficult to manage. We present a rare case of a 65-year-old male patient, with chronic lithiasic cholecystitis and cholecystocutaneous fistula. The patient underwent a laparoscopic subtotal cholecystectomy, dissection of the fistula tract, and removal of the impacted stones from the abdominal wall. With appropriate expertize, a completely laparoscopic approach is acceptable and the technical challenges can be predicted and overcome through careful pre-operative planning.

Spontaneous cholecystocutaneous fistula secondary to xanthogranulomatous cholecystitis: a case report.

BACKGROUND: Xanthogranulomatous cholecystitis, a rare variant of cholecystitis, may infrequently be complicated by spontaneous cholecystocutaneous fistula. CASE PRESENTATION: We report the case of a 75-year-old Saudi Arabian man who presented with "a painful area of redness" (cellulitis) over his right upper abdomen. Abdominal computed tomography revealed multiple collections, which were drained surgically. A discharging sinus was identified, and a fistulogram revealed cholecystocutaneous fistula during his follow-up visit. The patient underwent laparoscopic management and recovered uneventfully. Final histopathological evaluation confirmed acute-on-chronic xanthogranulomatous cholecystitis . CONCLUSIONS: Although rare, surgeons should consider cholecystocutaneous fistula in the differential diagnosis of anterior abdominal wall abscesses, particularly in patients with concurrent or background symptoms of gallbladder disease. We report the first case of laparoscopic management for cholecystocutaneous fistula in Saudi Arabia.

Fístula colecistocutánea espontánea / Spontaneous Cholecystocutaneous Fistula

Introducción: La incidencia de fístula colecistocutánea ha disminuido debido al abordaje quirúrgico precoz de los pacientes con litiasis vesicular. Objetivo: Presentar un caso de fístula colecistocutánea secundaria a colecistopatía litiásica crónica. Caso clínico: Paciente femenina de 87 años de edad que fue atendida en los servicios de urgencia de cirugía luego de haber sufrido, 2 semanas antes, dolor en hipocondrio derecho acompañado de aumento de volumen progresivo de dicha región. Al examen físico se constató secreción espontánea de bilis oscura de carácter continuo por orificio fistuloso. Se decide llevar al salón de operaciones y se le realizó colecistectomía de cuello a fondo y colangiografía transcística visualizándose litos. Se procedió a realizar coledocotomía, extracción de cálculos con lavado de la vía biliar y se colocó sonda en T. La evolución fue satisfactoria. Conclusiones: El tratamiento combinado de cirugía y antibioterapia es curativo(AU)

Introduction: The incidence of cholecystocutaneous fistula has decreased due to the early surgical managment of patients with vesicular lithiasis. Objective: To present a case of cholecystocutaneous fistula secondary to chronic lithiasic cholecystopathy. Clinical case: An 87-year-old female patient was attended in the emergency surgical services after having suffered, two weeks earlier, pain in the right hypochondrium accompanied by progressive increase in volume in that region. Physical examination revealed spontaneous discharge of dark bile continuously through a fistulous orifice. The patient was decided to be taken to the operating room, where she was performed a profound infundibulum cholecystectomy and transcystic cholangiography, lithiasis being visualized. The next considered step was choledochotomy for stone extraction with bile duct lavage, and a T-tube was placed. Evolution was satisfactory. Conclusions: The treatment combining surgery and antibiotic therapy is curative(AU)

Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract.

Cholecystocutaneous fistulas (CCFs) are an increasingly rare consequence of chronic gallbladder inflammation and disease. Historically, they were commonly noted in the literature by Courvoisier, Naunyn, and Bonnet in the late 1800s. Due to improvements in diagnostic imaging and treatment options in the last century, there has been a marked decrease in the incidence of the CCF cases in the literature. From the late 1890s to 1949, there were only 37 cases presented in the literature; only 28 cases have been reported since 2007. This case is only the second noted CCF in the literature that followed percutaneous cholecystostomy drain placement and removal. General surgery was consulted on a 60-year-old morbidly obese female, who presented to the emergency department after one week of fever, right upper quadrant (RUQ) pain, nausea, emesis, and shortness of breath. She had a history of acute cholecystitis treated with a cholecystostomy tube the year prior, but after the removal of the tube, she was lost to follow up. She was found to have a 14cm x 5cm fluctuant abdominal wall abscess in her RUQ that was treated with incision and drainage (I&D) along with ertapenem. She continued to improve until day 7 post-I&D when yellowish-green discharge was noted draining from the wound. After a negative hepatobiliary iminodiacetic acid scan, a follow-up abdominal computed tomography (CT) showed a contracted gallbladder with fistula formation underlying the abscess location, near the site of her prior cholecystostomy tube. A robotic-assisted cholecystectomy was performed, which improved the wound drainage, and the patient was discharged home 5 days later. This case is the only noted CCF presenting as a RUQ abscess after cholecystostomy drain placement. The patient lacks follow up after the removal of her percutaneous drain and continued inflammation in the gallbladder provided perfect nidus for the fistula formation. As seen in other CCF patients, cholecystectomy is the treatment of choice, and this case was successfully treated via robotic-assisted cholecystectomy with adhesiolysis.

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

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.

Cholecystoparietal Fistula Revealed by an Epigastric Abscess.

Cholecystocutaneous fistula, the ultimate complication of abscessed or overlooked acute cholecystitis, is due to perforation of the gallbladder in the abdominal wall. The authors report an unusual case of cholecystoparietal fistula revealed by an epigastric abscess. Fistulography and modern imaging tools make the diagnosis easier. Surgery is the best available treatment.

Right hypochondrial abscess: A rare consequence of supportive cholecystitis.

INTRODUCTION: Spontaneous cholecystocutaneous abscess is an extremely uncommon complication of acute suppurative cholecystitis. Over the past century very few cases of spontaneous cholecystocutaneous fistulas have been described in the medical literature. We, here, report a case of abdominal wall abscess secondary to cholecystocutaneous fistula. CASE REPORT: A 78 -year-old male presented as an emergency with a 2 days history of fever, malaise and a right subcostal mass. CT scan of abdomen showed huge abdominal wall abscess communicating intraabdominally to subhepatic area related to gallbladder. CONCLUSION: A high index of suspicion is necessary to diagnose this entity preoperatively and to avoid associated morbidity.

Unusual presentation of gallbladder perforation.

INTRODUCTION: Gall bladder perforation is associated with high mortality rates and therefore must be recognised and managed promptly. We present an unusual presentation of spontaneous gall bladder perforation. CASE PRESENTATION: An elderly lady with multiple medical co-morbidities was admitted with sepsis following a fall. Initial assessment lead to a diagnosis of pneumonia, however a rapidly expanding right flank mass was incidentally noted during routine nursing care. Imaging studies were inconclusive, however incision and drainage of the mass revealed bile stained pus draining cutaneously from an acutely inflamed gallbladder. The patient made a good recovery following surgery, and was discharged with outpatient follow-up. DISCUSSION: Despite focussed post-hoc history taking she denied any prodromal symptoms of cholecystitis. In addition to reporting an unusual cause for a common presentation, we highlight the importance of a full body examination in the context of sepsis, regardless of whether the source has been identified. In addition, we advocate that surgical intervention in sepsis should not be delayed by imaging in cases where an abscess is suspected. CONCLUSIONS: Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified.

Fístula colecistocutánea espontánea / Spontaneous cholecystocutaneous fistula

Background: Spontaneous cholecystocutaneous fistula is a rare complication of acute cholecystitis. The incidence has decreased due to prompt and early surgical management of patients with acute cholecystitis. Case report: We report a 64 years old woman consulting for erythematous soft and non-tender mass in right flank. Ultrasound revealed the cholecystocutaneous fistula. The fistulous tract and the gallbladder were excised from average laparotomy.

Introducción: La fístula colecistocutánea es una rara complicación de la colecistitis aguda. La incidencia de esta patología ha disminuido debido al abordaje quirúrgico precoz de los pacientes con colecistitis aguda. Caso clínico: Reportamos el caso de una mujer de 64 años de edad que consulta por un nódulo con signos inflamatorios en el flanco derecho. La fístula fue diagnosticada mediante ecografía. La fístula y la vesícula fueron extirpadas mediante una laparotomía media.

Cholecystocutaneous fistula after percutaneous gallbladder drainage.

Cases of cholecystocutaneous fistulas are now a rare occurrence as a result of rapid diagnosis and treatment. We present a case of cholecystocutaneous fistula developing after the removal of a percutaneous drain for the treatment of acute cholecystitis. Re-occurring infection and presence of gallstones led to fistulization of the gallbladder fundus and the development of a tract along the path created by the drain. The patient presented with re-occurring right upper quadrant abdominal pain, purulent discharge from the fistulous opening and expulsion of multiple gallstones. She underwent laparoscopic cholecystectomy and fistula excision.

Spontaneous cholecystocutaneous fistula-not an old time story.

Cases of spontaneous cholecystocutaneous fistula continue to attend surgical outpatient department in-spite of tremendous improvement in early diagnosis and treatment of gallbladder disease. It occurs as a complication of acute suppurative cholecystitis or neglected chronic cholecystitis due to cholelithiasis. We report two cases of spontaneous cholecystocutaneous fistula due to chronic cholecystitis with review of literature.

Spontaneous cholecysto-cutaneous fistula complicating carcinoma of the gall bladder: a case report.

Most cholecystocutaneous fistulas are postoperative complications of liver and biliary tract surgery or trauma. External biliary fistulas rarely occur spontaneously as a result of intrahepatic abscess (pyogenic or parasitic), necrosis or perforation of the gallbladder, or other inflammatory process involving the biliary tree. A cholecystocutaneous fistula as a presentation of an underlying cancer arising from the gall bladder is an extremely uncommon finding. Over the past 50 years fewer than 20 cases of spontaneous cholecystocutaneous fistulas have been described in the medical literature but so far there has been no published report of a cholecystocutaneous fistula arising from adenocarcinoma of gall bladder. We here report a case of a patient presenting with spontaneous cholecystocutaneous fistula from cancer of gall bladder.

Cholecystocutaneous fistula secondary to chronic calculous cholecystitis.

Spontaneous cholecystocutaneous fistula is an exceptionally unusual complication of chronic calculous cholecystitis now. The remarkable drop in incidence is probably associated with the introduction of antimicrobial therapy and early surgical management of biliary tract disease. We report a case of spontaneous cholecystocutaneous fistula in a patient who presented with an abscess in the right upper quadrant.

Anterior abdominal wall abscess secondary to subcutaneous gallstones.

Abdominal wall abscess secondary to spontaneous cholecystocutaneous gallstone fistulation is an uncommon presentation of a rare pathological process. Having been described relatively frequently in the 19th century, it is now much less common in the late 20th and early 21st century, probably due to earlier recognition of symptoms, better imaging and surgical treatment of biliary tract disease. Here we describe a report of a case with an unusual clinical presentation of the already rare pathological disease process of spontaneous cholecystocutaneous fistula.