The Road Less TravelledLeighann Henehan

AC 65 year old

Surgical referral, abdominal wall abscess (RUQ)

Incision & drainage

Non-healing wound EUA

Clinical course Non-healing, discharging sinus (MRSA

–ve)

Background hx: Coeliac

Hypertension

Examination under Anaesthesia

Sinus opening

Fistula tract

Gallbladder opened

Gallstone retrieved Cholecystostomy

Catheter placed

Histology: Fistula tract, no evidence of malignancy

Catheter removed 2/12; Wound fully healed 3/12.

Cholecystocutaneous Fistula

Abnormal communication between gallbladder & skin

Spontaneous or deliberate

Complication of chronic cholecystitis

Obstruction necrosis perforation abscess fistula

Cholecystocutaneous Fistula

1st described by Thilesus 1670

>100 cases 1890’s by Courvoisier

Incidence has reduced due to prompt diagnosis; antibiotics & early surgical intervention

Very rare, fewer than 20 cases reported worldwide since 1950’s

Isolated reports secondary to GB Ca & acalculous cholecystitis

Presentation Elderly; Female > Male

Suggestive biliary disease

Empyema necessitatis or discharging sinus

On examination: septic; erythematous tender raised area RUQ; external opening

Treatment Cholecystostomy vs Cholecystectomy

Learning Points

Fistula vs Sinus

Types of Gallstones

Complications of gallstones

Questions?