Cholecystocutaneous fistula complicating percutaneous drainage of a pericholecystic abscess, managed conservatively

Cholecystocutaneous fistula (CCF) is a rare complication of gallbladder disease, in which an epithelialized tract forms between the gallbladder and skin. Its incidence has fallen with modern imaging, antibiotics and early cholecystectomy; an increasingly recognised cause is percutaneous gallbladder drainage. Definitive treatment is cholecystectomy with en bloc tract excision, but management of high-risk patients is poorly defined. We report a CCF arising 8 months after image-guided percutaneous drainage of a pericholecystic abscess in a 91-year-old nursing home resident with multiple comorbidities. Given high operative and anaesthetic risk, the fistula was managed conservatively with a stoma appliance and multidisciplinary support. At 3 months she remained well, with a matured, intermittently draining fistula and spontaneous gallstone extrusion. To our knowledge this is the first iatrogenic CCF reported in a nonagenarian, and the first with serial photographic documentation of its evolution, supporting conservative containment as a safe, patient-centred alternative to surgery.