A Case of Cholecystocutaneous Fistula with Extrahepatic Portal Obstruction

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  • 肝外門脈閉塞症を合併した胆嚢皮膚瘻の1例
  • 症例 肝外門脈閉塞症を合併した胆囊皮膚瘻の1例
  • ショウレイ カン ガイ モンミャク ヘイソクショウ オ ガッペイ シタ タンノウ ヒフロウ ノ 1レイ

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Abstract

In acute cholecystitis, the gallbladder becomes inflamed and inflammation extends to the surrounding organs to form pericholecystic, hepatic, and subdiaphragmatic abscesses. It is relatively uncommon that the inflammation penetrates the abdominal wall to form abdominal abscess and then to become a cholecystocutaneous fistula. Recently we have experienced a case of cholecystocutaneous fistula with extrahepatic portal obstruction. The case involved an 82-year-old woman who presented to our hospital because of a one-week history of a painful right hypochondriac tumor. An abdominal CT scan showed a soft tissue tumor in the right-sided abdominal wall. The gallbladder had shrunk but was present close to the tumor. We identified extrahepatic portal obstruction at the same time. The patient was admitted for close exploration. On the next day, the tumor spontaneously ruptured and dark-red pus was discharged. Fistulography revealed communication with the gallbladder, and choecystocutaneous fistula was diagnosed. Cholecystectomy, fistulectomy and partial colectomy were performed under laparotomy. Histopathology showed no malignant findings, and we diagnosed the case as cholecystocutaneous fistula and extrahepatic portal obstruction associated with gallstone cholecystitis. With a recent progression of medical treatment, cholecystocutaneous fistula has become a rare entity. So far no cases of cholecystocutaneous fistula associated with extrahepatic portal obstruction have been reported as far as we could review.

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