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Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract.
Cureus 2019; 11(4):e4444C

Abstract

Cholecystocutaneous fistulas (CCFs) are an increasingly rare consequence of chronic gallbladder inflammation and disease. Historically, they were commonly noted in the literature by Courvoisier, Naunyn, and Bonnet in the late 1800s. Due to improvements in diagnostic imaging and treatment options in the last century, there has been a marked decrease in the incidence of the CCF cases in the literature. From the late 1890s to 1949, there were only 37 cases presented in the literature; only 28 cases have been reported since 2007. This case is only the second noted CCF in the literature that followed percutaneous cholecystostomy drain placement and removal. General surgery was consulted on a 60-year-old morbidly obese female, who presented to the emergency department after one week of fever, right upper quadrant (RUQ) pain, nausea, emesis, and shortness of breath. She had a history of acute cholecystitis treated with a cholecystostomy tube the year prior, but after the removal of the tube, she was lost to follow up. She was found to have a 14cm x 5cm fluctuant abdominal wall abscess in her RUQ that was treated with incision and drainage (I&D) along with ertapenem. She continued to improve until day 7 post-I&D when yellowish-green discharge was noted draining from the wound. After a negative hepatobiliary iminodiacetic acid scan, a follow-up abdominal computed tomography (CT) showed a contracted gallbladder with fistula formation underlying the abscess location, near the site of her prior cholecystostomy tube. A robotic-assisted cholecystectomy was performed, which improved the wound drainage, and the patient was discharged home 5 days later. This case is the only noted CCF presenting as a RUQ abscess after cholecystostomy drain placement. The patient lacks follow up after the removal of her percutaneous drain and continued inflammation in the gallbladder provided perfect nidus for the fistula formation. As seen in other CCF patients, cholecystectomy is the treatment of choice, and this case was successfully treated via robotic-assisted cholecystectomy with adhesiolysis.

Authors+Show Affiliations

Otolaryngology, McLaren Oakland Hospital, Pontiac, USA.General Surgery, United Hospital Center, Bridgeport, USA.Family Medicine, United Hosptial Center, Bridgeport, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31205832

Citation

Lofgren, Daniel H., et al. "Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula Via Percutaneous Cholecystostomy Tract." Cureus, vol. 11, no. 4, 2019, pp. e4444.
Lofgren DH, Vasani S, Singzon V. Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract. Cureus. 2019;11(4):e4444.
Lofgren, D. H., Vasani, S., & Singzon, V. (2019). Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract. Cureus, 11(4), pp. e4444. doi:10.7759/cureus.4444.
Lofgren DH, Vasani S, Singzon V. Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula Via Percutaneous Cholecystostomy Tract. Cureus. 2019 Apr 12;11(4):e4444. PubMed PMID: 31205832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract. AU - Lofgren,Daniel H, AU - Vasani,Sugam, AU - Singzon,Victorico, Y1 - 2019/04/12/ PY - 2019/6/18/entrez PY - 2019/6/18/pubmed PY - 2019/6/18/medline KW - abdominal pain KW - abscess KW - cholecystectomy KW - cholecystocutaneous fistula KW - non-compliance KW - percutaneous cholecystostomy SP - e4444 EP - e4444 JF - Cureus JO - Cureus VL - 11 IS - 4 N2 - Cholecystocutaneous fistulas (CCFs) are an increasingly rare consequence of chronic gallbladder inflammation and disease. Historically, they were commonly noted in the literature by Courvoisier, Naunyn, and Bonnet in the late 1800s. Due to improvements in diagnostic imaging and treatment options in the last century, there has been a marked decrease in the incidence of the CCF cases in the literature. From the late 1890s to 1949, there were only 37 cases presented in the literature; only 28 cases have been reported since 2007. This case is only the second noted CCF in the literature that followed percutaneous cholecystostomy drain placement and removal. General surgery was consulted on a 60-year-old morbidly obese female, who presented to the emergency department after one week of fever, right upper quadrant (RUQ) pain, nausea, emesis, and shortness of breath. She had a history of acute cholecystitis treated with a cholecystostomy tube the year prior, but after the removal of the tube, she was lost to follow up. She was found to have a 14cm x 5cm fluctuant abdominal wall abscess in her RUQ that was treated with incision and drainage (I&D) along with ertapenem. She continued to improve until day 7 post-I&D when yellowish-green discharge was noted draining from the wound. After a negative hepatobiliary iminodiacetic acid scan, a follow-up abdominal computed tomography (CT) showed a contracted gallbladder with fistula formation underlying the abscess location, near the site of her prior cholecystostomy tube. A robotic-assisted cholecystectomy was performed, which improved the wound drainage, and the patient was discharged home 5 days later. This case is the only noted CCF presenting as a RUQ abscess after cholecystostomy drain placement. The patient lacks follow up after the removal of her percutaneous drain and continued inflammation in the gallbladder provided perfect nidus for the fistula formation. As seen in other CCF patients, cholecystectomy is the treatment of choice, and this case was successfully treated via robotic-assisted cholecystectomy with adhesiolysis. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/31205832/Abdominal_Wall_Abscess_Secondary_to_Cholecystocutaneous_Fistula_via_Percutaneous_Cholecystostomy_Tract L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31205832/ DB - PRIME DP - Unbound Medicine ER -