Spontaneous external biliary fistula in a patient with heroin addiction

Spontaneous external biliary fistula, once common, is now a rare clinical entity. A patient with this lesion is described and attention is drawn to the fact that this rare condition is still being seen in certain patients with neglected cholecystitis. Heroin addiction was thought to have modified his response to gallbladder disease and contributed to the perforation. Diagnosis was suspected on physical examination and confirmed by spontaneous discharge of stones and fistulogram.