<Case Reports>So-called Spontaneous Cholecysto-Subcutaneous Fistula : A Case Report

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  • <症例>特発性の胆嚢腹壁皮下瘻の1例

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The frequency of external biliary fistula is very rare when iatrogenic and traumatic fistulae are excluded. A 67-year-old male suffering from choledocholithiasis and chronic cholecystitis was admitted on January 11,1984. The patient had complained of occasional attacks of bronchial asthma for ten years. On additional evaluations, scout films and CT of the abdomen demonstrated a small calcified mass in the RUQ of the abdominal wall ; however, the etiology of the mass was unknown. DIC revealed a partially calcified stone in the common bite duct and a shrunk gallbladder. Laparotomy was performed on February 8,1984. Marked fibrinous adhesions were noted adherent to the liver and extrahepatic biliary system. At cholecystectomy, the fundus of the gallbladder seemed to be buried into the internal oblique muscle and the subcutaneous tissues. Although macroscopic appearance of the resected specimen resembled an hourglass gallbladder, histologic examination of the distal extraperitoneal portion revealed a chronic granulomatous cavity of abscess. In such cases, direct invasion of calculous cholecystitis is considered to be responsible for the development of the fistula. Decreased intracystic pressure due to incidental stone migration into the common duct may play a role for the long-standing symptom-free external biliary fistula. His postoperative course has been uneventful.

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