2002, Number 1
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ABSTRACTObjective: To report the case of a female patient with a spontaneous cholecysto-cutaneous fistula due to chronic cholecystolithiasis.
Setting: Third level health care hospital.
Description of the case: Eighty-five years old woman with clinical symptoms of abdominal pain of two years of evolution, localized at the right hypochondrium, draining purulent yellow-greenish material through an orifice of approximately 1 mm, located on the right sub-costal region. She received antimicrobial treatment, which induced closure of the orifice and stopped the purulent material drainage. Two weeks before her admittance to the hospital the pain reappeared and the orifice re-opened. A fistulogram was performed through the sub-costal orifice and a fistulous tract was visualized from the abdominal wall to the gallbladder; the cystic duct and the choledochus were permeable. She was treated surgically, first laparoscopically but had to be converted to open surgery due to technical difficulties. Partial cholecystectomy was performed resecting the fistulous tract. At present, she is asymptomatic.
Conclusion: A spontaneous cholecysto-cutaneous fistula must be suspected based on the clinical characteristics and the presence of an orifice in the right sub-costal region.
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