BACKGROUND:Cholecystocolocutaneous fistula (CCCF) is a rare complication of gallstone disease resulting from spillage of gallstones from perforation of an empyema of the gallbladder, which can pose diagnostic dilemmas. We describe a patient, who presented initially with a swelling followed by discharging sinuses on her right flank where a diagnosis of CCCF was made and was treated surgically with satisfactory outcome. METHODS:A computed tomography (CT) scan showed an ill-defined soft tissue mass in the right subhepatic space and a fistulogram demonstrated passage of contrast into the gallbladder fossa and hepatic flexure of colon. At laparotomy, a cutaneous fistula containing two pigment stones led to the gallbladder fossa and hepatic flexure of colon. RESULTS:Debridement of infected granulation tissues which had replaced the gallbladder, closure of the cystic duct stump and colonic fistula followed by excision of the fistula tract led to complete resolution. CONCLUSIONS:CCCF is a rare complication of perforated gallbladder with spillage of calculi, and a fistulogram is helpful in establishing the diagnosis. This case highlights the importance of retrieving spilled stones following interventions in the gallbladder to prevent the complication.

译文

背景:胆囊管皮肤瘘(CCCF)是胆囊积脓性穿孔引起胆结石溢出引起胆结石疾病的罕见并发症,可引起诊断难题。我们描述了一名患者,该患者最初出现红肿,然后在其右牙侧排出鼻窦,在那里做出了CCCF的诊断,并接受了手术治疗,结果令人满意。
方法:计算机断层扫描(CT)扫描显示右肝下间隙有模糊不清的软组织肿块,而瘘管图显示造影剂进入胆囊窝和结肠肝弯曲。在剖腹手术中,包含两个色素结石的皮肤瘘导致胆囊窝和结肠的肝弯曲。
结果:清创的感染肉芽组织清创了胆囊,闭合了胆囊管残端和结肠瘘,然后切除了瘘管,从而彻底解决了问题。
结论:CCCF是胆囊穿孔伴结石溢出的罕见并发症,瘘管造影有助于诊断。该病例强调了在胆囊内进行干预以防止并发症后取出溢出的结石的重要性。

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