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?