Mir Sarfaraz Mahmood.
Spontaneous cholecysto-cutaneous fistula.
J Rawal Med Coll Jan ;17(1):148-9.

Spontaneous cholecystocutaneous fistula is a rare clinical entity. It is generally due to neglected gallbladder disease but rarely it could be due to postoperative adhesions. We present a case report of spontaneous cholecystocutaneous fistula both due to impacted gallstone at the neck of gallbladder and postoperative adhesions. Clinical, radiological and endoscopic means were used to diagnose and manage this patient. Patient underwent laparoscopic assisted open cholecystectomy and excision of the fistula with uneventful recovery. Diagnosis of cholecystocutaneous fistula was made clinically. It was confirmed by fistulogram performed by inserting a Foley's catheter through the fistula. Fistulogram also helped to diagnose a stone in the common bile duct (CBD) in our case, which was subsequently extracted successfully by ERCP. Interestingly this CBD stone was not found on abdominal ultrasound. Fistulogram is the investigation of choice to confirm the cholecystocutaneous fistula. Spontaneous cholecystocutaneous fistula should be considered in the differential diagnosis if encountered with an abscess at the right upper quadrant.

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