The Road Less Travelled Leighann Henehan

AC 65 year old Surgical referral, abdominal wall abscess (RUQ) Incision & drainage Non-healing wound  EUA

Clinical course Non-healing, discharging sinus (MRSA –ve) Background hx: Coeliac Hypertension Examination under Anaesthesia

Sinus opening

Fistula tract

Gallbladder opened

Gallstone retrieved Cholecystostomy Catheter placed Histology: Fistula tract, no evidence of malignancy Catheter removed 2/12; Wound fully healed 3/12.

Cholecystocutaneous Fistula Abnormal communication between gallbladder & skin Spontaneous or deliberate Complication of chronic cholecystitis Obstruction necrosis perforation  abscess fistula

Cholecystocutaneous Fistula 1st described by Thilesus 1670 >100 cases 1890’s by Courvoisier Incidence has reduced due to prompt diagnosis; antibiotics & early surgical intervention Very rare, fewer than 20 cases reported worldwide since 1950’s Isolated reports secondary to GB Ca & acalculous cholecystitis

Presentation Elderly; Female > Male Suggestive biliary disease Empyema necessitatis or discharging sinus On examination: septic; erythematous tender raised area RUQ; external opening

Treatment Cholecystostomy vs Cholecystectomy

Learning Points Fistula vs Sinus Types of Gallstones Complications of gallstones

Questions?