Cholecystocutaneous abscess: diagnostic difficulty in a groin lump

Area of Science:

• Gastroenterology
• General Surgery
• Diagnostic Imaging

Background:

• Inguinal hernias are common surgical presentations, particularly in older patients.
• A tender groin lump can indicate various pathologies, including hernias and abscesses.
• Accurate pre-operative diagnosis is crucial for appropriate surgical planning.

Observation:

• An elderly patient presented with a four-week history of a tender right groin lump, initially presumed to be a strangulated inguinal hernia.
• Surgical exploration revealed an abscess communicating with the abdominal cavity, not a hernia.
• Due to inadequate consent for further procedures, the operation was abandoned, and CT imaging was arranged.

Findings:

• Computed tomography (CT) unexpectedly diagnosed a cholecystocutaneous abscess, a rare condition where the gallbladder connects to the skin.
• The abscess was discharging through the right inguinal region, mimicking a hernia.
• The patient recovered clinically with conservative management, including ongoing abscess drainage.

Implications:

• This case highlights the importance of considering rare diagnoses even when classic symptoms are present.
• CT imaging is invaluable for diagnosing complex abdominal pathologies presenting in unusual ways.
• Non-operative management can be successful for certain abscesses, avoiding unnecessary surgical intervention.