title: Unusual aetiology of abdominal wall abscess: cholecystocutaneous fistula presenting 20 years after open subtotal cholecystectomy.
abstract: A 68-year-old woman presented to the emergency department, with an abscess in the right upper anterior abdominal wall. She had a medical history of an open cholecystectomy 20 years prior, diabetes, obesity and a laparotomy for perforated sigmoid diverticular disease complicated by a large parastomal hernia. CT revealed this subcutaneous abscess to track intra-abdominally through the liver and communicate with the gallbladder fossa. The abscess was incised and drained. The wound initially drained pus, and then bile. Magnetic resonance cholangiopancreatogram (MRCP) demonstrated a remnant gallbladder containing 2 gallstones, a cholecystocutaneous fistula, portal vein thrombosis and cavernous transformation of the bile duct. The patient improved and was discharged. The patient's case history and imaging were discussed with the tertiary referral centre, in a multidisciplinary team. After an extensive and balanced discussion, the patient declined a completion cholecystectomy and continues to have occasional discharge from the fistula in her right upper quadrant.
authors.affiliation: St George's Hospital, London, UK.
authors.forename: William
authors.initials: W
authors.lastname: Maynard
authors.affiliation: Kingston Hospital, Kingston Upon Thames, UK.
authors.forename: Emma Rose
authors.initials: ER
authors.lastname: McGlone
authors.affiliation: Kingston Hospital, Kingston Upon Thames, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Deguara
mesh_terms: D034861:Abdominal Wall; D000038:Abscess / Q000209:etiology* / Q000628:therapy; D000368:Aged; D001658:Biliary Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D002763:Cholecystectomy / Q000009:adverse effects*; D017577:Cutaneous Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal