Abstract
Spontaneous cholecystocutaneous abscess or fistula is an extremely uncommon complication secondary to cholecystitis. Over the past 50 years fewer than 20 cases of spontaneous cholecystocutaneous fistulas have been described in the medical literature. We here report a case of subcutaneous gallstone as a rare clinical presentation of the already uncommon cholecystocutaneous fistula. An 81-year-old man presented with a large subcutaneous abscess in the right subcostal area with surrounding cellulitis and crepitus. An abdominal computed tomography scan showed two subcutaneous gallstones and communication between the abscess and the gallbladder. Cholecystectomy was performed and the abdominal wall abscess was drained externally. This case report demonstrates that maintaining a high degree of suspicion of this rare entity is helpful in achieving correct preoperative diagnosis, and that computed tomography scan should be performed in all cases of unexplained abdominal wall suppuration or cellulitis.
Highlights
Spontaneous cholecystocutaneous abscess or fistula is an extremely uncommon complication of gallbladder disease that has been known since the time of Thilesius in 1670
We have reported a rare case of spontaneous gallbladder perforation resulting in cholecystocutaneous abscess with multiple gallstones inside it
There has not been any other case of cholecystocutaneous abscess or fistula presenting with multiple subcutaneous gallstones in the English-language medical literature since 1949.1
Summary
Spontaneous cholecystocutaneous abscess or fistula is an extremely uncommon complication of gallbladder disease that has been known since the time of Thilesius in 1670. We here report a case of subcutaneous gallstones as a rare clinical presentation of the already uncommon cholecystocutaneous fistula. The immediate postoperative course was uneventful; three days later, the patient presented an acute onset of chest pain, dyspnea and refractory shock from massive pulmonary embolism, in spite of prophylaxis for deep vein thrombosis. He died in the intensive care unit 12 hours later
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