Asian Journal of Case Reports in Surgery

Post Cholecystectomy Cholecysto-Cutaneous Fistula with Concomitant Common Bile Duct Stone: A rare case study

Adianto Nugroho *

Digestive Surgery Division, Fatmawati Central General Hospital, Indonesia.

Perwira Widianto

Digestive Surgery Division, Persahabatan Central General Hospital, Indonesia.

Indah Jamtani

Digestive Surgery Division, Fatmawati Central General Hospital, Indonesia.

Rofi Y. Saunar

Digestive Surgery Division, Fatmawati Central General Hospital, Indonesia.

*Author to whom correspondence should be addressed.

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Abstract

Cholecysto-cutaneous fistula (CF) formation following cholecystectomy is a rare surgical condition. We report a case of post cholecystectomy CF in a 37-year-old male who presented with bile-like mucous discharge from the healed cholecystectomy scar. He was previously treated for gallbladder empyema presented with acute and severe cholecystitis by percutaneous cholecystostomy followed by open subtotal reconstituting cholecystectomy in another hospital. Intermittent pain on the surgical site and occasional mucous discharge from the surgical scar started two months after the surgery and was left untreated for almost a year. The patient presented in our emergency room (ER) with obstructive jaundice and cholangitis, along with an apparent bile fistula. Magnetic resonance imaging (MRI) confirmed the diagnosis of cholecysto-cutaneous fistula along with distal common bile duct (CBD) stone. We performed an open cholecystectomy, fistula excision, bile duct exploration, and a choledocho-duodenostomy bypass. Post cholecystectomy cholecysto-cutaneous fistula is a rare clinical entity that could happen after a complex cholecystectomy operation. MRI best describes the fistula with the possibility of concomitant stones. One-step surgery should minimize the possible morbidity and complications after multiple-step surgery in treating gallbladder empyema.

Keywords: Gallbladder empyema, cholecysto-cutaneous fistula, magnetic resonance imaging, cholecystectomy

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