Cholecystocutaneous fistula occurring through the chest wall

Abstract

Background: Spontaneous cholecystocutaneous fistula (SCCF) is nowadays a very rare entity. The treatment consists in broad-spectrum antibiotics, drainage of subcutaneous abscess if present, and cholecystectomy in fit patients.It usually occurs through the abdominal wall. We describe a rare case of cholecystocutaneous fistula occurring through the chest wall. Methods: A 68 year-old female patient was referred with a right anterior chest wall abscess. The patient had a history of obesity and schizophrenia. Following skin incision, a large amount of yellowish and purulent discharge was obtained from the abscess. CT-scan showed a communication between the gallbladder and a subcutaneous collection of the right anterior chest wall containing a 5 x 2 cm gallstone. The large stone was retrieved from the chest wall and the fistulous tract was tutorized with a Foley catheter ending into the gallbladder as confirmed by intraoperative fistulogram. An obstructive CBD stone was also visualized and therefore the patient underwent an ERCP and the foley catheter was removed posteriorly. Results: The patient was discharged and 6 weeks later received a laparoscopic cholecystectomy. The postoperative course was uneventful. Histology of the gallbladder did not show malignancy. Conclusion: SCCF is a rare entity and extrabdominal cutaneous tract is even rarer. If a good drainage can be achieved, delayed laparoscopic cholecystectomy can be safely performed. Presence of gallstones along the tract should always be ruled out.