Spontaneous cholecystocutaneous fistula as the presenting manifestation of IgG4-related disease

Abstract

A 79-year-old woman with an unremarkable past medical history presented to the outpatient surgery clinic with a 30-day history of dull abdominal pain. She had noticed a skin orifice in the supraumbilical region discharging a yellowish serous material. Ultrasound showed findings of chronic cholelithiasis. An x-ray fistulogram disclosed a 3.9-inch-long fistulous tract from the skin to the gallbladder (Fig 1) confirming the diagnosis of spontaneous cholecystocutaneous fistula. An abdominal CT showed diffuse and smooth thickening of the gallbladder wall with multiple calcified gallstones.