Cases Of Gallstones Research Articles

Fetal Gallstones: Antenatal Detection and Management

Fetal gallstones are a rare sonographic finding. We came across two cases of fetal gallstones detected in routine third trimester scan over a period of one year. Both cases were confirmed to have gallstones in postnatal scan and showed complete resolution of the gallstones at 35 and 45 days after birth. The presence of gallstones in the fetus does not alter the fetal prognosis or obstetrical management since complete resolution is seen in most of the cases in late third trimester or neonatal period which may be due to either spontaneous passage of gallstones during early neonatal period or dilution of cholesterol crystals with postnatal hydration.

Is there an association between type 1 diabetes in children and gallbladder stones formation?

Background and Aims:A number of studies in adults have evaluated the prevalence of gallstones in the diabetic population and showed a significant association with type 1 diabetes (T1D) and type 2 diabetes. The pediatric literature is limited to a single small case series. We conducted a cross-sectional study to evaluate for the presence of association between T1D in children and gallstones formation.Patients and Methods:Children diagnosed with T1D in a diabetic clinic have been examined for existence of gall bladder stone formation from November 2008 through November 2009. All have been subjected to the following: History, physical examination, blood tests (liver function tests, lipid profile, glycosylated hemoglobin [HbA1C]), and an ultrasound (US) of the gall bladder.Results:One hundred and five children with T1D have been enrolled consecutively over a 1-year period: age ranged between 8 months and 15.5 years, 62 patients were females. The mean age at diagnosis was 6.3 ± 2.9 years (range 0.85-11 years), mean duration of T1D was 2.2 ± 2.1 years (range 0.2-8 years), mean body mass index was 16.5 ± 3.4, mean HbA1c was 10.7 ± 2.4%, and 61.3% of patients had a HbA1c level >10%. The mean serum cholesterol was 4.16 ± 0.75 mmol/L (normal 3.65-5.15 mmol/L) and mean serum triglyceride 1.02 ± 1.3 mmol/L (normal 0-1.7 mmol/L). Two patients had hyperlipidemia. US of the gallbladder did not show any case of gallstones or sludge formation.Conclusion:Data from our study do not show any association between T1D in children and gallstones formation, with diabetes duration of less than 8 years. The relatively short duration of diabetes and possibility that our study was underpowered might have been reasons for the absence of any association.

腹腔鏡下胆嚢摘出術時の腹腔内落下結石が背部に穿破した1例

症例は74歳の男性．胆嚢結石，総胆管結石，急性胆管炎にて当院入院となった．総胆管結石に対し，経内視鏡的乳頭括約筋切開術を施行後，腹腔鏡下胆嚢摘出術を施行した．術中腹腔内落下結石を認めたが鉗子にて回収した．術後より発熱，腹痛が持続し，術後第3病日に施行した腹部CTにて大量のfree airと十二指腸の炎症性肥厚を認めた．術中操作による消化管穿孔を疑い，同日緊急開腹手術を施行した．手術所見では胆嚢床部を中心に膿性腹水と炎症性変化を認めたが，明らかな消化管穿孔部は認めず，洗浄ドレナージ術のみ施行した．術後炎症反応が遷延し，腹部CTにて肝下面に結石像と膿瘍形成を認めたが，保存的加療により軽快し，術後第43病日に退院となった．退院後外来経過観察していたが，初回手術より約4カ月後に右背部腫瘤が出現した．腹部CT上，肝下面から連続する腹壁膿瘍を認め，皮下に結石と思われる高信号が確認された．同日切開排膿を行い，創部より経5mm大の結石を計4個排石した．その後の腹部CTにて結石は認めず，経過良好にて退院となった．

The aetiology of symptomatic gallstones quantification of the effects of obesity, alcohol and serum lipids on risk. Epidemiological and biomarker data from a UK prospective cohort study (EPIC-Norfolk)

The development of gallstones is influenced by obesity and alcohol. This study aimed to precisely quantify these risks and investigate whether the aetiological mechanism may involve serum lipids, for the first time using a European prospective cohort study. The European Prospective Investigation into Cancer-Norfolk, recruited 25 639 men and women, aged 40 to 74 years, between 1993 and 1997. At enrolment weight, height and alcohol intake were recorded and nonfasting blood samples taken to measure serum triglycerides, cholesterol, high-density lipoproteins and low-density lipoproteins. The cohort was monitored for 14 years for symptomatic gallstones. Cox regression estimated sex-specific hazard ratios (HRs) for symptomatic gallstones adjusted for covariates. Symptomatic gallstones developed in 296 people (67.9% women). For each additional unit of BMI, the HR in men was 1.08 [95% confidence interval (CI)=1.02-1.14]; in women the HR was 1.08 (95% CI=1.06-1.11). Every unit of alcohol consumed per week decreased risk in men by 3% (HR=0.97, 95% CI=0.95-0.99) with no effect in women. Serum triglycerides increased risk in men (highest vs. lowest quarter HR=2.02, 95% CI=1.03-3.98) and women (HR=2.43, 95% CI=1.52-3.90). Increased high-density lipoprotein was associated with a decreased risk in men (highest vs. lowest quarter HR=0.22, 95% CI=0.09-0.52) and women (HR=0.55, 95% CI=0.36-0.85). No effects were found for serum cholesterol and low-density lipoprotein. Obesity and alcohol influence gallstone formation, possibly in part through their effects on serum lipids. Reducing obesity may prevent gallstones in the population, as 38% of incident cases of gallstones were associated with a BMI of more than 25.

Charcot's triad

Biliary stones are usually found in the gallbladder, but about 10-20% may spontaneously migrate into the common bile duct where they either remain trapped or migrate subsequently via the papilla of Vater into the duodenal lumen. In some cases, biliary stones may form de novo in the common bile duct because of local precipitating factors. We here present a spectacular case of huge gallstones impacted in the common bile duct (empierrement of the common bile duct) that led to the development of acute cholangitis with septic shock. Urgent nocturnal percutaneous cholangiography permitted biliary drainage and resolution of the cholangitis while the stones were secondarily removed surgically because of the large size of the stones.Acute suppurative cholangitis may be fatal unless adequate biliary drainage is obtained in a timely manner. The association of fever and rapid onset of jaundice in elderly patients should always make physicians think of cholangitis.

A Case of Gallstone Ileus Treated with Electrohydraulic Lithotripsy Guided by Colonoscopy

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.

Long-term Statin Use and the Risk of Gallstone Disease: A Population-based Case-Control Study

Most gallstones originate from cholesterol-supersaturated bile. Statins inhibit hepatic cholesterol biosynthesis and therefore may reduce the risk of gallstone disease. Population-based evidence, however, is sparse. Thus, the authors conducted a population-based case-control study using medical databases from northern Denmark (1.7 million inhabitants) to identify 32,494 cases of gallstones occurring between 1996 and 2008 and to identify age-, sex-, and county-matched population controls for each case. Cases and their matched controls who were exposed to lipid-lowering drugs were categorized as current users if their last prescription was redeemed ≤90 days before the case's diagnosis date; otherwise, they were categorized as former users. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for gallstone disease in patients treated with lipid-lowering drugs. In current users, the adjusted odds ratios associating statin use with the occurrence of gallstone disease were 1.17 (95% confidence interval (CI): 1.06, 1.30) for those who had 1-4 prescriptions, 0.89 (95% CI: 0.80, 0.97) for those who had 5-19 prescriptions, and 0.76 (95% CI: 0.69, 0.84) for those who had ≥20 total prescriptions. In former users, the corresponding adjusted odds ratios were 1.24 (95% CI: 1.11, 1.39), 0.97 (95% CI: 0.86, 1.10), and 0.79 (95% CI: 0.64, 0.97), respectively. The use of other lipid-lowering drugs showed no similar association.

当科における超高齢者 (80歳以上) 胆石症救急症例の治療方針 胆管炎症例を中心に

当科における超高齢者 (80歳以上) 胆石症救急症例の治療方針 胆管炎症例を中心に

PTH-079 Direct-to-test endoscopic ultrasound

Introduction Endoscopic ultrasound (EUS) has become an invaluable investigation in the assessment of pancreatobiliary disease. EUS is superior to abdominal ultrasound in pancreatobiliary imaging having a sensitivity of >90% for choledocholithiasis and affording better views of the pancreas. Traditionally, patients tend to undergo EUS following specialist review. We are not aware of any reports of direct-to-test EUS for patients who have been assessed only by a general practitioner (GP). We propose that, in selected patients with suspected choledocholithiasis, direct-to-test EUS is safe and avoids specialist clinic review and the attendant delay, expense and inconvenience. Here we present our initial data on direct-to-test EUS in a teaching hospital setting. Methods Twenty-four patients who had been referred to the gastroenterology department at our institution by their general practitioners between February 2005 and July 2009 were selected to be offered direct-to-test EUS. Selected patients had liver chemistry and/or symptomatology compatible with biliary pathology; all but one patient had had an abdominal ultrasound scan before referral. A patient information leaflet was sent in the post along with the appointment letter. Results All patients accepted direct-to-test EUS appointment; the average time from referral to procedure was 6 weeks. The average patient age was 59 years (range 21–83); 17 out of 24 patients were female (71%). The clinical details were: biliary-type pain with abnormal liver chemistry but normal ducts on ultrasound (n=14); abnormal liver chemistry with duct dilatation but no stones identified on ultrasound (n=4); biliary-type pain, normal chemistry, with duct dilatation but no stones on ultrasound (n=3); progressive cholestatic liver chemistry post cholecystectomy with no duct dilatation on ultrasound (n=2); unexplained recent pancreatitis with a normal ultrasound (n=1). The EUS findings for the 24 patients were: normal examination (n=13), choledocholithiasis (n=3), gallstones (n=5), hepatic steatosis (n=2), periampullary tumour (n=1). Three of the cases of gallstones had not been previously identified on abdominal ultrasound scanning. The overall yield for pathology was 46%. There were no noted complications in any of the 24 cases. On the basis of the EUS examination, three patients were referred for ERCP, two for cholecystectomy, and one for a Whipple9s procedure. This equates to a 25% onward referral rate for definitive treatment based on the direct-to-test EUS findings. Conclusion Our initial data support the hypothesis that direct-to-test EUS for selected patients with suspected biliary disease is a safe investigation, with a high yield of significant pathology.

One case of gallstone with granuloma in gastric wall

1.临床资料:女,63岁,住院号:575707.以发作性右上腹疼痛15年,再发4个月为主诉于2008年8月11日入院.病人近来有畏寒、恶心呕吐.入院前曾在当地医院及本院门诊治疗,腹痛缓解.入院查体:T 36.8℃,BP 130/80 mm Hg,P 72次/min,R 20次/min。

Association lithiase vésiculaire et cavernome porte chez l’enfant : « à propos de 2 observations »

The association of cholelithiasis and portal cavernoma is rarely described in adult or pediatric patients. We report 2 cases of gallstone associated with portal cavernoma in 2 girls. The first one suffered from Evans syndrome associated with congenital immune deficiency. The portal cavernoma was discovered with gallstone after splenectomy indicated because of high steroid dependence. In the second case, the cavernoma complicated neonatal umbilical catheterism. The gallstone was asymptomatic and discovered on annual ultrasonography. Septicemia, profound thrombocytopenia, and acute anaemia led to rapid death in the first case. However, the progression was favourable under celioscopic treatment in the second one. Our original observations suggest systematically searching for gallstone in children with portal cavernoma.

Risk Factors, Complications, and Outcomes of Gallstones in Children: A Single‐center Review

The increasing use of sonography has resulted in an increase in the proportion of children with gallstones who are asymptomatic at the time of diagnosis. In adults, the literature supports expectant management of clinically silent gallstones. The evidence for this management approach in children is limited to a number of small series. Our objective was to review the risk factors, complications, and outcomes of gallstones at our institution, particularly in those patients who are asymptomatic at the time of initial diagnosis. We reviewed 382 cases of gallstones in children. These patients were diagnosed with sonography. Data on age at diagnosis, presentation, sonographic findings, risk factors, complications, surgery, and follow-up were collected. A chi2 test was used to compare the complication rates between symptomatic and asymptomatic groups. Descriptive statistics were used to analyze the sample. At diagnosis, 50.5% of children were asymptomatic; these patients were diagnosed at a mean age of 8.23 years. Compared with symptomatic patients, they were less likely to have a hemolytic anemia but more likely to have other risk factors, including cardiac surgery, leukemia and lymphoma, short bowel syndrome, or exposure to total parenteral nutrition or cephalosporins. These patients had a lower rate of complications than the symptomatic patients (4.6% vs 28.2% of symptomatic, P < 0.0001) and only 3.1% developed symptoms that necessitated surgery (vs 59.0% of symptomatic). Of the 58 (15.1%) diagnosed in infancy, 47 (81.0%) were asymptomatic. The infant group also had low rates of complications (8.6%) and cholecystectomy (1.7%). In cases with sonographic follow-up, resolution of gallstones was demonstrated in 16.5% of asymptomatic patients and in 34.1% of infants. The data suggest that clinically silent gallstones in children and infants are associated with low rates of complications and can be managed conservatively, unless complications occur. Patients with sickle cell disease, spherocytosis, and elliptocytosis had high complication rates and required surgery more often.

Androgen receptor CAG repeat length and risk of biliary tract cancer and stones.

Biliary tract cancers, encompassing cancers of the gallbladder, extrahepatic bile ducts, and ampulla of Vater, are rare but highly fatal. Gallstones represent the major risk factor for biliary tract cancer, and share with gallbladder cancer a female predominance and an association with reproductive factors and obesity. Although estrogens have been implicated in earlier studies of gallbladder cancer, there are no data on the role of androgens. Because intracellular androgen activity is mediated through the androgen receptor (AR), we examined associations between AR CAG repeat length [(CAG)(n)] and the risk of biliary tract cancers and stones in a population-based study of 331 incident cancer cases, 837 gallstone cases, and 750 controls from Shanghai, China, where the incidence rates for biliary tract cancer are rising sharply. Men with (CAG)(n) >24 had a significant 2-fold risk of gallbladder cancer [odds ratio (OR), 2.00; 95% confidence interval (CI), 1.07-3.73], relative to those with (CAG)(n) < or = 22. In contrast, women with (CAG)(n) >24 had reduced gallbladder cancer risk (OR, 0.69; 95% CI, 0.43-1.09) relative to those with (CAG)(n) < or = 22; P interaction sex = 0.01, which was most pronounced for women ages 68 to 74 (OR, 0.48; 95% CI, 0.25-0.93; P interaction age = 0.02). No associations were found for bile duct cancer or gallstones. Reasons for the heterogeneity of genetic effects by gender and age are unclear but may reflect an interplay between AR and the levels of androgen as well as estrogen in men and older women. Further studies are needed to confirm these findings and clarify the mechanisms involved.

Partial splenectomy for children with congenital hemolytic anemia and massive splenomegaly

Partial splenectomy is an alternative to total splenectomy for the treatment of congenital hemolytic anemias (CHAs) in children, although the feasibility of this technique in the setting of massive splenomegaly is unknown. This study was designed to evaluate the safety and efficacy of partial splenectomy in children with CHAs and massive splenomegaly. This retrospective study examined 29 children with CHAs who underwent partial splenectomy. Children were divided into 2 groups based on splenic size: 8 children had splenic volumes greater than 500 mL, whereas 21 children had splenic volumes less than 500 mL. Outcome variables included perioperative complications, transfusion requirements, hematocrits, reticulocyte counts, bilirubin levels, splenic sequestration, and splenic regrowth. All 29 children underwent successful partial splenectomy with 0.02 to 10 years of follow-up. After partial splenectomy, children overall had decreased transfusion requirements, increased hematocrits, decreased bilirubin levels, decreased reticulocyte counts, and elimination of splenic sequestration. Children with massive splenomegaly had similar outcomes compared with children without massive splenomegaly. Long-term complications included 3 mild infections, 4 cases of gallstones requiring cholecystectomy, and 1 child who required completion splenectomy. Partial splenectomy is a safe, effective, and technically feasible option for children with various CHAs, even in the setting of massive splenomegaly.

Long-Term Effect of Magnesium Consumption on the Risk of Symptomatic Gallstone Disease Among Men

Magnesium deficiency can cause dyslipidemia and insulin hypersecretion, which may facilitate gallstone formation. However, the effect of long-term consumption of magnesium on the risk of gallstone disease is unknown. We prospectively studied magnesium consumption and risk of gallstone disease in a cohort of 42,705 U.S. men from 1986 to 2002. Magnesium consumption was assessed using a validated semiquantitative food frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially. We documented 2,195 incident cases of symptomatic gallstones during 560,810 person-years of follow-up. The age-adjusted relative risks (RRs) for men with total magnesium intake and dietary magnesium, when the highest and lowest quintiles were compared, were 0.67 (95% confidence interval [CI] 0.59-0.77, P for trend <0.0001) and 0.67 (CI 0.59-0.76, P for trend <0.0001), respectively. After adjusting for multiple potential confounding variables, when extreme quintiles were compared, the multivariate RR of total magnesium intake (RR 0.72, CI 0.61-0.86, P for trend = 0.006) and dietary magnesium (RR 0.68, CI 0.57-0.82, P for trend = 0.0006) remained significant with a dose-response relationship. Our findings suggest a protective role of magnesium consumption in the prevention of symptomatic gallstone disease among men.

Haplotype analysis of signal peptide (insertion/deletion) and XbaI polymorphisms of the APOB gene in gallbladder cancer

The incidence of gallbladder cancer (GBC) is usually paralleled by the prevalence of gallstone disease, and genes of cholesterol metabolism have been implicated in gallstone disease. The XbaI and insertion/deletion (ins/del) polymorphism of Apolipoprotein B (APOB) appears to influence cholesterol homoeostasis and possibly risk for gallstone disease. We examined the effect of these polymorphisms individually as well as their haplotypes on GBC and gallstone patients in North Indian population. The study comprises 123 consecutive cases of proven GBC, 172 cases of gallstone and 232 healthy subjects of similar age and sex. The genomic DNA was extracted from peripheral blood leucocytes and genotyping was performed using polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. In a case-control study, APOB XbaI and ins/del polymorphisms were not significantly associated with risk of GBC. Using the expectation maximization algorithm, four haplotypes were obtained, and haplotype X(+),D was found to be significantly higher in GBC patients without stone in comparison with healthy subjects [odds ratio (OR) 2.9, 95% confidence interval 1.2-6.6 P=0.012]. The X(+),D haplotype of APOB is associated with increased risk for development of GBC and the risk is not modified in the presence of gallstones.

Heme and non-heme iron consumption and risk of gallstone disease in men

Background:Excessive iron intake can promote biliary cholesterol crystal formation in experimental studies. The absorption of heme iron is more complete than that of non-heme iron in humans; however, the effect of long-term consumption of heme and non-heme iron on the risk of gallstones is unknown.Objective:The objective of the study was to examine long-term iron intake in relation to the occurrence of gallstone disease.Design:We prospectively studied intakes of heme and non-heme iron and the risk of gallstone disease in a cohort of 44 758 US men from 1986 to 2002. Iron consumption was assessed by using a validated semiquantitative food-frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially.Results:We documented 2468 incident cases of symptomatic gallstones during 597 699 person-years of follow-up. The age-adjusted relative risks (RRs) for men with intakes of heme iron and non-heme iron, when the highest and lowest quintiles were compared, were 1.21 (95% CI: 1.06, 1.37; Pfor trend = 0.0008) and 1.02 (95% CI: 0.90, 1.16; Pfor trend = 0.45), respectively. After adjustment for multiple potential confounding variables, when extreme quintiles were compared, the multivariate RR of heme iron intake was not significantly changed and remained significant with a dose-response relation (RR = 1.21; 95% CI: 1.03, 1.42; Pfor trend = 0.01), and that of non-heme iron intake was not significant (RR = 1.14; 95% CI: 0.99, 1.31; Pfor trend = 0.18).Conclusion:Our findings suggest that a higher consumption of heme iron is associated with a greater risk of gallstone disease among men.

Weight Cycling and Risk of Gallstone Disease in Men

The long-term effect of repeated intentional weight loss and weight regain on the risk of gallstone disease in men is not clear. Participants in the Health Professionals Follow-up Study provided information on intentional weight loss during the previous 4 years in 1992. Weight cyclers were men who had intentional weight loss and weight regain. Men free of gallstone disease at baseline were followed from 1992 to 2002. On biennial questionnaires the participants reported newly diagnosed gallstone disease. During 264,760 person-years of follow-up we ascertained 1222 cases of symptomatic gallstones. We examined the effect of weight cycling on the risk of gallstone disease. The multivariate relative risk of weight cyclers, compared with weight maintainers, after adjusting for potential confounding variables, including body mass index, was 1.11 (95% confidence interval [CI], 0.94-1.31) in light cyclers, 1.18 (95% CI, 0.97-1.43) in moderate cyclers, and 1.42 (95% CI, 1.11-1.81) in severe cyclers. We further examined the effect of number of cycling episodes. Among weight cyclers, the relative risk associated with having more than 1 weight cycle, compared with weight maintainers, was 1.10 (95% CI, 0.88-1.37) in light cyclers, 1.28 (95% CI, 1.03-1.59) in moderate cyclers, and 1.51 (95% CI, 1.13-2.02) in severe cyclers. Our findings suggest that weight cycling, independent of body mass index, may increase the risk of gallstone disease in men. Larger weight fluctuation and more weight cycles are associated with greater risk.

Weight Cycling and Risk of Gallstone Disease in Men

Purpose: Large weight fluctuations earlier in life may represent an independent risk factor for chronic diseases including metabolic syndrome. Weight cycling is associated with overshoots of lipogenic enzymes and insulin in experiments. The long-term effect of repeated intentional weight loss and weight regain on the risk of gallstone disease in men is unknown. Methods: We examined the relations of weight cycling to the risk of gallstone disease in a large cohort of men. As part of the Health Professionals Follow-up Study in the US, men provided information on intentional weight loss during the previous 4 years using validated questionnaires in 1992. The Pearson correlation between self-reported weight and measured weight by technicians was 0.97. Weight cyclers were men who had intentional weight loss and weight regain. Weight cyclers were further divided into three categories: light cyclers (maximum intentional weight loss per episode of 5 to 9 lb), moderate cyclers (maximum intentional weight loss per episode 10 to 19 lb), and severe cyclers (maximum intentional weight loss per episode of 20 lb or more). Men free of gallstone disease at baseline were followed from 1992 to 2002. On biennial questionnaires the participants reported newly diagnosed gallstone disease. A validation study of self-reported gallstone disease was conducted. Results: During 264,760 person-years of follow-up we ascertained 1,222 new cases of symptomatic gallstones. We examined the effect of weight cycling on the risk of gallstone disease. The multivariate relative risk (RR) of weight cyclers, compared with weight maintainers, after adjusting for multiple potential confounding variables including body mass index, was 1.11 (95% C.I., 0.94 to 1.31) in light cyclers, 1.18 (95% C.I., 0.97 to 1.43) in moderate cyclers, and 1.42 (95% C.I., 1.11 to 1.81) in severe cyclers. We further examined the effect of number of cycling episodes. Among weight cyclers the RR associated with having more than one weight cycle, compared with weight maintainers, was 1.10 (95% C.I., 0.88 to 1.37) in light cyclers, 1.28 (95% C.I., 1.03 to 1.59) in moderate cyclers, and 1.51 (95% C.I., 1.13 to 2.02) in severe cyclers. Conclusions: Our findings suggest that weight cycling, independent of weight, may increase the risk of gallstone disease in men. Larger weight fluctuation and more weight cycles are associated with greater risk.

Spontaneous cholecystocutaneous fistula: a rare complication of gallbladder disease

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.