A Case of Spotaneous Cholecystocutaneous Fistula Associated with Carcinoma of the Neck of the Gallbladder

Kazuhisa Shitoh, Noriyuki Endoh, Tomoo Shirakura, Youji Yoshida*

Department of Surgery, Tsuru City Hospital

We encountered a patient with a spontaneous cholecystocutaneous fistula associated with carcinoma of the gallbladder. The patient, a 94-year-old man, who had had a cerebral infarction and chronic subdural hematoma and cholecystitis, was referred to our hospital for a tumor-forming skin fistula in the right hypochodrium. a gree-brownish discharge through this fistula resembled biliary juice, but fistulography did not reveal communication with the biliary tract. The cytological diagnosis of this discharge was class II. The patient received resection of the fistula and drainage because of his age. But after this operation the borwnish exudation did not cease, and repeated fistulography revealed communication between the skin and the gallbladder. Therefore cholecystectomy and fistulectomy were performed as the second operation. The postoperative pathological analysis revealed adenocarcinoma on the site between the cystic duct and the neck of the gallbladder, although it was not seen in the gallbladder base communicating with the fistula. We thought that in this case cholecystitis with obstruction in the cystic duct caused the perforation in the gallbladder based and the penetration into the abdominal wall. In patients with a past history of biliary tract problems, spontaneous cholecystocutaneous fistula should be considered if a tumor-forming fistula is encountered in the right hypochondrium, and also chlecystocholedocholithiasis and carcinoma of the gallbladder should be considered.

Key words
spontaneous cholecystocutaneous fistula, carcinoma of the gallbladder, high aged patient

Reprint requests
Kazuhisa Shitoh The Department of Surgery, Jichi Medical School
3313 Yakushiji, Minamikawauchimachi Kawauchigun, Tochigi Pref., 329-04 JAPAN

Accepted
September 9, 1997

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