title: Cholecystocutaneous fistula: an unusual complication of a para-umbilical hernia repair.
abstract: This case describes a 94-year-old woman who presented 2 years postsutured para-umbilical hernia repair with a painful black lump protruding through her scar with blood stained discharge. This was initially thought to be either ischaemic bowel secondary to strangulated incisional hernia or a large organised haematoma. An urgent CT scan was performed following which the patient passed two large calculi and bile-stained fluid spontaneously through the wound, making the diagnosis somewhat clearer. The scan revealed an incisional hernia containing the gallbladder and two large calculi at the skin surface and an incidental large caecal cancer with surrounding lymphadenopathy. Frail health and the incidental finding of a colon cancer rendered invasive surgical management inappropriate. Therefore, she was managed conservatively with antibiotics. A catheter was inserted into the fistula tract to allow free drainage and alleviate pressure-related symptoms. The patient was discharged following a multidisciplinary team discussion.
authors.affiliation: Department of General Surgery, Sunderland Royal, Newcastle Upon Tyne, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Sunderland Royal Hospital, Sunderland, UK.
authors.forename: Mitesh
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Sunderland Royal Hospital, Sunderland, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Holtham
mesh_terms: D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D042882:Gallstones / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed