Journal of Rare Disorders: Diagnosis & Therapy

A Right Hypochondrial Discharging Sinus not to be Missed-"Spontaneous Cholecystocutaneous Fistula"

Spontaneous Chole-Cystocutaneous Fistula (CCF) is a rare complication of cholelithiasis, which has only been reported a few times in the literature. We report the case of a 59 years old woman who presented with a discharging sinus in the epigastrium. CCF is a type of external biliary fistula, which connects the gallbladder with the skin. Thilesus first described this phenomenon in 1670. There is usually a history of calculi in the gallbladder or neglected gallbladder disease. The incidence of CCF is rare, most patients being elderly females with the mean age of 72.8 years old. Ultrasound, CT, MRI, MRCP and (CT or X-ray) fistulogram are used to confirm the diagnosis. CT was more significant than US in identifying the fistulous tract. Open cholecystectomy with excision of the fistulous tract is considered an acceptable option for treatment and it is curative in most cases. However, laparoscopic approach can be another option in experienced hands. Our patient underwent hepaticojejunostomy with en block skin, aponeurotic muscle, fistula tract, gallbladder, cystic duct, part of the common bile duct and hepatic duct excision. This case report demonstrates that maintaining a high degree of suspicion of this rare entity is helpful in achieving correct preoperative diagnosis and that computed tomography scan should be performed in all cases of unexplained abdominal wall suppuration or cellulitis.

Author(s): A R M Isthiyak* and Anura SK Banagala

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