Spontaneous Cholecystocutaneous Fistula

Area of Science:

• Gastroenterology
• Surgical Case Reports

Background:

• Spontaneous cholecystocutaneous fistula is an exceedingly rare complication of chronic calculous cholecystitis.
• Early diagnosis and treatment of gallstones have made this complication highly infrequent.

Observation:

• A 90-year-old female presented with diarrhea, fever, and an erythematous abdominal swelling.
• Ultrasonography revealed gallbladder wall abnormalities, an impacted gallstone, and a purulent collection adjacent to the abdominal wall.
• Diagnosis of spontaneous cholecystocutaneous fistula with an abdominal abscess was established.

Findings:

• Conservative management, including fluids, antibiotics, and CT-guided drainage, was initiated due to high anesthetic risk.
• The patient showed initial clinical and laboratory improvement.
• Despite management, the patient experienced a sudden arrhythmic event and expired on the third day of hospitalization.

Implications:

• This case highlights that spontaneous cholecystocutaneous fistula, though rare, can occur even with early gallstone management.
• It underscores the importance of considering unusual presentations of cholecystitis in elderly patients with comorbidities.
• Management strategies for such rare complications require careful consideration of patient risk factors.