title: Spontaneous cholecystocutaneous fistula draining from an abdominal scar from previous surgical drainage.
abstract: We present a rare case of cholecystocutaneous fistula draining from an old surgical scar in the right upper abdominal quadrant following chronic calculous cholecystitis. A 71 year old male presented to the emergency department with a persistent bilious drainage from an old surgical scare, from surgical drainage, of the right upper abdominal quadrant for about a week. Cultures from the draining fluid grew Staphylococcus hominis, Escherichia coli and Klebsilla pneumoniae and tigecycline 50 mg twice a day was administrated intravenously to the patient according to sensitivity results. An abdominal US revealed the presence the gallbladder with calculi in a superficial position and the fistulogram revealed a cholecystocytaneous fistula arising from the fundus of the gallbladder. At laparotomy a fistula track was found connecting the gallbladder fundus to the skin, which was dissected and a cholecystectomy was performed. Spontaneous cholecystocutaneous fistula is rarely observed today, mostly as a complication of chronic calculous cholecystitis. Most often it arises from the gallbladder fundus and the clinical presentation is that of a painless draining sinus tract in the right upper quadrant. Diagnosis is aided by abdominal CT scan and ultrasound and treatment is with elective cholecystectomy and excision of the fistula.
authors.affiliation: First Surgical Department, General Regional Hospital 'George Papanikolaou', Thessaloniki, Greece. telonakos@hotmail.com
authors.forename: Orestis
authors.initials: O
authors.lastname: Ioannidis
authors.forename: George
authors.initials: G
authors.lastname: Paraskevas
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kotronis
authors.forename: Stavros
authors.initials: S
authors.lastname: Chatzopoulos
authors.forename: Athina
authors.initials: A
authors.lastname: Konstantara
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papadimitriou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Makrantonakis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Kakoutis
mesh_terms: D000005:Abdomen; D000368:Aged; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002763:Cholecystectomy; D002764:Cholecystitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002908:Chronic Disease; D002921:Cicatrix / Q000150:complications*; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome