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Cholecystitis with Spontaneous Cholecysto-Cutaneous Fistula

Merdrignac A, Cusumano C and Sulpice L*

Department of Hepatobiliary and Digestive Surgery, Service de chirurgie hépatobiliaire et Digestive, CHU Pontchaillou, Rennes, France

*Corresponding Author:
Laurent Sulpice
Department of Hepatobiliary and Digestive Surgery
Service de chirurgie hépatobiliaire et Digestive
CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France
Tel: +33 299288498
Fax: +33 299284129
E-mail: [email protected] fr

Received Date: February 12, 2018; Accepted Date: February 16, 2018; Published Date: February 18, 2018

Citation: Merdrignac A, Cusumano C, Sulpice L (2018) Cholecystitis with Spontaneous Cholecysto-Cutaneous Fistula. Med Case Rep Vol.4 No. 2:I12. DOI: 10.21767/2471-8041.S1-I012

 
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Abstract

Background An external biliary fistula is a rare complication of gallstone disease. We present a case of cholecystocutaneous fistula successfully treated with excision and cholecystectomy. Case outline An 87-year old woman presented to the emergency department with an abdominal inflammatory mass in the right flank increasing for 15 days. Results Physical examination revealed signs of decompensated heart failure associated with hypothermia. Abdominal ultrasound showed a fluid collection in the right abdominal wall evaluated to 15x13x6 cm containing air bubbles and a stone. Discussion This condition is never seen today because of the bigger availableness of computerized axial tomography confirmed associate symptom within the paries containing a three cm stone ad lib exhausted from the vesica. The symptom and therefore the stone were exhausted with a body covering incision concerning the symptom below anesthesia.

Clinical Image

An 87-year old woman presented to the emergency department with an abdominal inflammatory mass in the right flank increasing since 15 days. Physical examination revealed signs of decompensated heart failure associated with hypothermia.

Abdominal ultrasound showed a fluid collection in the right abdominal wall evaluated to 15 × 13 × 6 cm containing air bubbles and a stone. Computed tomography confirmed an abscess in the abdominal wall containing a 3 cm stone spontaneously evacuated from the gallbladder (Figure 1). The acute heart failure contraindicated general anesthesia.

medical-case-reports-Gallstone-migrated

Figure 1: Gallstone migrated from the gall-bladder into an abscess in the anterior abdominal wall.

The abscess and the stone were evacuated with a cutaneous incision regarding the abscess under local anesthesia. Microbiological examination of the pus showed E. coli and M. morganii. The patient received an anti-biotherapy with ciprofloxacin for 2 weeks.

Hypothermia and biological inflammatory signs disappeared. Acute cholecystitis could go unnoticed in old patients. They may only have symptoms at an advanced stage with complications due to chronic inflammation.

Spontaneous fistulas between the gallbladder and the duodenum, the colon or the abdominal wall could appear. In those cases, the aim of the surgical treatment is to treat the complication such as occlusion or abscess but not the fistula.

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