BACKGROUND: Cholecystocolocutaneous fistula (CCCF) is a rare complication of gallstone disease resulting from spillage of gallstones from perforation of an empyema of the gallbladder, which can pose diagnostic dilemma...BACKGROUND: Cholecystocolocutaneous fistula (CCCF) is a rare complication of gallstone disease resulting from spillage of gallstones from perforation of an empyema of the gallbladder, which can pose diagnostic dilemmas. We describe a patient, who presented initially with a swelling followed by discharging sinuses on her right flank where a diagnosis of CCCF was made and was treated surgically with satisfactory outcome. METHODS: A computed tomography (CT) scan showed an ill-defined soft tissue mass in the right subhepatic space and a fistulogram demonstrated passage of contrast into the gallbladder fossa and hepatic flexure of colon. At laparotomy,a cutaneous fistula containing two pigment stones led to the gallbladder fossa and hepatic flexure of colon. RESULTS: Debridement of infected granulation tissues which had replaced the gallbladder, closure of the cystic duct stump and colonic fistula followed by excision of the fistula tract led to complete resolution. CONCLUSIONS: CCCF is a rare complication of perforated gallbladder with spillage of calculi, and a fistulogram is helpful in establishing the diagnosis. This case highlights the importance of retrieving spilled stones following interventions in the gallbladder to prevent the complication.展开更多
Preauricular sinus is a common congenital malformation. Unusual presentations can be subtle with some difficulty in obtaining diagnosis. A 27-year-old woman with 6 months history of recurrent right postauricular swell...Preauricular sinus is a common congenital malformation. Unusual presentations can be subtle with some difficulty in obtaining diagnosis. A 27-year-old woman with 6 months history of recurrent right postauricular swelling which was initially thought to be a recurrent mastoid abscess presented. She had repeated incision and drainage with recurrent post auricular abscess. An incidental extravasation of fluid from an asymptomatic preauricular sinus during postauricular abscess cavity irrigation and a positive fistulogram revealed the diagnosis. Combined excision of the preauricular sinus tract and postauricular abscess cavity achieved a good outcome with patient been asymptomatic over a period of one-year follow-up. There should be a high index of suspicion of recurrent abscesses in close proximity with an ipsilateral preauricular sinus in the head and neck region.展开更多
文摘BACKGROUND: Cholecystocolocutaneous fistula (CCCF) is a rare complication of gallstone disease resulting from spillage of gallstones from perforation of an empyema of the gallbladder, which can pose diagnostic dilemmas. We describe a patient, who presented initially with a swelling followed by discharging sinuses on her right flank where a diagnosis of CCCF was made and was treated surgically with satisfactory outcome. METHODS: A computed tomography (CT) scan showed an ill-defined soft tissue mass in the right subhepatic space and a fistulogram demonstrated passage of contrast into the gallbladder fossa and hepatic flexure of colon. At laparotomy,a cutaneous fistula containing two pigment stones led to the gallbladder fossa and hepatic flexure of colon. RESULTS: Debridement of infected granulation tissues which had replaced the gallbladder, closure of the cystic duct stump and colonic fistula followed by excision of the fistula tract led to complete resolution. CONCLUSIONS: CCCF is a rare complication of perforated gallbladder with spillage of calculi, and a fistulogram is helpful in establishing the diagnosis. This case highlights the importance of retrieving spilled stones following interventions in the gallbladder to prevent the complication.
文摘Preauricular sinus is a common congenital malformation. Unusual presentations can be subtle with some difficulty in obtaining diagnosis. A 27-year-old woman with 6 months history of recurrent right postauricular swelling which was initially thought to be a recurrent mastoid abscess presented. She had repeated incision and drainage with recurrent post auricular abscess. An incidental extravasation of fluid from an asymptomatic preauricular sinus during postauricular abscess cavity irrigation and a positive fistulogram revealed the diagnosis. Combined excision of the preauricular sinus tract and postauricular abscess cavity achieved a good outcome with patient been asymptomatic over a period of one-year follow-up. There should be a high index of suspicion of recurrent abscesses in close proximity with an ipsilateral preauricular sinus in the head and neck region.
