title: A rare case of gallbladder fistulation with a 60-year-old appendicectomy scar.
abstract: We present an extremely unusual case of an external biliary fistula in an 87-year-old woman who presented with a 1-day history of spontaneous green discharge from a 60-year-old appendicectomy scar. Examination revealed a sinus in the right iliac fossa overlying her appendicectomy scar, with a raised white cell count and C reactive protein. A CT scan revealed a complex fistula connecting the gallbladder to the subcutaneous tissue in the right flank, which further connected inferiorly with a fistula to the previous appendicectomy scar and a small iliopsoas collection. Endoscopic retrograde cholangiopancreatography revealed several stones in the common bile duct, which were removed using a balloon catheter. The patient was further managed with a long course of antibiotics and discharged with a long-term drainage bag. A literature search revealed no previously reported cases of an external biliary fistula communicating with an appendicectomy scar.
authors.affiliation: Conquest Hospital, Saint Leonards on Sea, UK.
authors.forename: Gajendiran
authors.initials: G
authors.lastname: Thiruchandran
authors.affiliation: Conquest Hospital, Saint Leonards on Sea, UK.
authors.forename: Megan
authors.initials: M
authors.lastname: Joyce
authors.affiliation: East Sussex Healthcare NHS Trust, East Sussex, UK.
authors.forename: Paul James
authors.initials: PJ
authors.lastname: Baggott
mesh_terms: D000005:Abdomen / Q000473:pathology; D000369:Aged, 80 and over; D001062:Appendectomy; D001658:Biliary Fistula / Q000175:diagnosis* / Q000473:pathology; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology; D002921:Cicatrix; D017577:Cutaneous Fistula / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005704:Gallbladder / Q000473:pathology*; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D010388:Pelvis / Q000473:pathology