Cholecystocutaneous Fistula as a First Sign of Presentation of a Gallbladder Adenocarcinoma

  • Fı́stula colecistocutánea
  • Published 2017

Abstract

Cholecysto-cutaneous fistulas are a rare surgical entity.They are associated with complications of cholecystitis, empyema, gallbladder carcinoma with local extension, or after surgery. We present the case of a cholecysto-cutaneous fistula as a form of presentation of gallbladder adenocarcinoma. The patient was an 83-year-old male with no prior history except for a previous episode of acute cholecystitis 2 years earlier, which had been treated conservatively with antibiotics and fluid therapy at another hospital. He came to the Emergency Department of our hospital complaining of abdominal pain in the right upper quadrant associated with the oozing of hematicpurulent content through an orifice in the abdominal wall located in the right hypochondrium. Abdominal examination revealed a mass in this region. The patient presented important anemia in the blood work-up (Hb 6 g/dl), although he was hemodynamically stable. Abdominal CT demonstrated a collection measuring 98 mm 78 mm 90 mm that was located predominantly in the extraperitoneal region, with hematic content in its interior, extending from the gallbladder bed to the subcutaneous tissue that fistulized through the skin (Figs. 1 and 2). A right subcostal laparotomy was performed; a large hematoma situated in the gallbladder bed was evacuated, the gallbladder and the fistulous tract from the gallbladder fundus to the abdominal wall were removed. The cutaneous fistula orifice was excised with the associated cholecystectomy. The pathology study reported moderately differentiated papillary adenocarcinoma, with infiltration of the cystic duct and abdominal wall (T3N0M0). The patient was discharged after an uneventful postoperative recovery. Neoplasms of the bile duct are uncommon and are associated with a poor prognosis. Gallbladder carcinoma (GBC) represents 3% of malignant tumors and is fifth in the order of frequency within the group of gastrointestinal malignant neoplasms. The annual incidence of GBC ranges between 2 and 13/100 000 inhabitants. The most common age of presentation is between 65 and 75. In 95% of cases, the most frequent histologic type is adenocarcinoma, and there seems to be a clear association with cholelithiasis, porcelain gallbladder, repeated gallbladder infections, bile duct anomalies and benign gallbladder tumors, among others. Gallstones are the main associated factor; some studies have found that the risk for developing GBC in patients with gallstones is 1%– 3%. As for the pathogenesis of this entity, chronic inflammation due to several stimuli has been implicated, and it is thought that the adenoma–carcinoma sequence is present in many cases of GBC. Early-stage GBC presents with non-specific symptoms that are similar to cholelithiasis, while in advanced cancer more significant symptoms can appear, such as weight loss, jaundice, anorexia, ascites and palpable mass in the right hypochondrium, associated with a poorer prognosis and tumor irresectability. Because of this presentation, less than 50% of GBC cases

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Cite this paper

@inproceedings{colecistocutnea2017CholecystocutaneousFA, title={Cholecystocutaneous Fistula as a First Sign of Presentation of a Gallbladder Adenocarcinoma}, author={Fı́stula colecistocut{\'a}nea}, year={2017} }