A Case of Cholecystocutaneous Fistula with Dropped Stones in the Abdominal Wall Abscess Treated by Elective Laparoscopic Subtotal Cholecystectomy and Percutaneous Stone Removal

Abstract

A 60-year-old female patient visited our hospital with the chief complaint of a painful right upper abdominal mass that had persisted for 2 weeks. Abdominal computed tomography (CT) revealed gallbladder atrophy, circumferential wall thickening, and an abdominal wall abscess extending from the gallbladder fundus. Based on the findings, we diagnosed the patient as having acute cholecystitis, cholecystocutaneous fistula, and abdominal wall abscess. Initially, two parts of the gallbladder and abdominal wall were drained percutaneously. Although the signs of inflammation improved immediately, multiple dropped gallstones were found in the abdominal wall abscess cavity. Consequently, on the 23rd day of hospitalization, we performed laparoscopic subtotal cholecystectomy, fistula resection, and percutaneous removal of the stones. The postoperative course was favorable, and the patient was discharged in good condition on the fifth postoperative day. There has been no recurrence of the abdominal wall abscess or cholangitis after discharge. Despite recognizing a complex infection status, we were able to complete minimally invasive procedure safely by initial percutaneous drainage, followed by elective laparoscopic surgery and percutaneous stone removal.