Download presentation
Presentation is loading. Please wait.
1
The Road Less Travelled
Leighann Henehan
2
AC 65 year old Surgical referral, abdominal wall abscess (RUQ)
Incision & drainage Non-healing wound EUA
3
Clinical course Non-healing, discharging sinus (MRSA –ve)
Background hx: Coeliac Hypertension Examination under Anaesthesia
4
Sinus opening
5
Fistula tract
6
Gallbladder opened
7
Gallstone retrieved Cholecystostomy Catheter placed
Histology: Fistula tract, no evidence of malignancy Catheter removed 2/12; Wound fully healed 3/12.
8
Cholecystocutaneous Fistula
Abnormal communication between gallbladder & skin Spontaneous or deliberate Complication of chronic cholecystitis Obstruction necrosis perforation abscess fistula
9
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
10
Presentation Elderly; Female > Male Suggestive biliary disease
Empyema necessitatis or discharging sinus On examination: septic; erythematous tender raised area RUQ; external opening
11
Treatment Cholecystostomy vs Cholecystectomy
12
Learning Points Fistula vs Sinus Types of Gallstones
Complications of gallstones
13
Questions?
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.