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CASE REPORT
Spontaneous cholecystocutaneous fistula: empirically treated for a missed diagnosis, managed by laparoscopy
  1. Manjunath Maruti Pol1,
  2. Surabhi Vyas2,
  3. Priyanka Singh3 and
  4. Yashwant Singh Rathore1
  1. 1 Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Radiology, All India Institute of Medical Sciences, New Delhi, India
  3. 3 Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  1. Correspondence to Dr Manjunath Maruti Pol, manjunath.pol{at}gmail.com

Abstract

A 70-year-old woman was referred to our hospital from primary health centre with complaints of pain in the abdomen, swelling and discharging sinus in the right hypochondrium since 2 years. She had received anti-tubercular treatment for 18 months as the wedge biopsy of the sinus tract suggested granulomatous lesion. As the symptoms did not subside she was referred to our hospital. Her blood investigation reports at our hospital were normal. Ultrasound of the abdomen suggested cholelithiasis with normal common bile duct. CT fistulogram findings were diagnostic of cholecystocutaneous fistula (CCCF). She underwent laparoscopic cholecystectomy and excision of the sinus tract. Postoperative recovery was uneventful. Indiscriminate usage of anti-tubercular drugs should be discouraged and possibility of CCCF should be considered in patients presenting with discharging sinus in the anterior abdominal wall. CT fistulogram is helpful in making diagnosis of CCCF. Cholecystectomy with excision of the sinus tract is the treatment of choice.

  • Cholecystocutaneous fistula
  • discharging tuberculoma
  • anti-tubercular treatment
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Footnotes

  • Patient consent for publication Obtained.

  • Contributors MMP conceived the design. MMP was the first operating surgeon; Patient was evaluated, worked up and discussed by PS. SV was involved in radiological discussion and arriving at diagnosis. Patient was operated by MMP. YSR collected the operating steps videography photographs. Demography of the patient, clinical details and video editing was done by PS and YSR and further it was analysed by MMP. Manuscript was prepared by MMP, SV and YSR. Editing of image and video was performed by PS. Case report was written, critically analysed, revised and uploaded by MMP. Final approval of the case report is provided by MMP, SV, PS and YSR. Overall responsibility and corresponding author is MMP, SV, YSR, PS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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