Cirugía y Cirujanos. 2015; 83(1): 61-64

CIRUGÍA y CIRUJANOSÓrgano de difusión científica de la Academia Mexicana de Cirugía

Fundada en 1933

www.amc.org.mx www.elservier.es/circir

0009-7411/© 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

CLINICAL CASE

☆

Fernando Guardado-Bermúdeza,*, Araceli Aguilar-Jaimesa, Fernando Josafat Ardisson-Zamoraa, Luis Alberto Guerrero-Silvaa, Estefanie Villanueva-Rodríguezb and Nubia Alondra Gómez-de Leijac

a Servicio de Cirugía General, Departamento de Cirugía, Hospital Civil de Ciudad Madero, Ciudad Madero, Tamaulipas, Méxicob Servicio de Medicina Interna, Departamento de Cirugía, Hospital Civil de Ciudad Madero, Ciudad Madero, Tamaulipas, Méxicoc Servicio de Medicina General, Departamento de Cirugía, Hospital Civil de Ciudad Madero, Ciudad Madero, Tamaulipas, México

Received 10 June 2013; accepted 21 January 2014

☆Please cite this article as: Guardado-Bermúdez et al. Fístula colecistocutánea espontánea. Cirugía y Cirujanos. 2015; 83: 61-64.*Corresponding author: Calle Miguel Ramos 606, Col. Luna Luna. C.P. 89519, Ciudad Madero, Tamaulipas, México. Teléfono: 01 (833) 1265 579.E-mail address: fernandoguardadob@hotmail.com (F. Guardado Bermúdez).

KEYWORDS

Cholecystocutaneous;Fistulogram

AbstractBackground:

seventeenth century by Thilesus. During the past 50 years, 25 cases have been reported.Clinical case:

-

Discussion:

Conclusion: -rent trend is to become an entity anecdotal. The subcostal abdominal examination approach remains

© 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

2444-0507

62 F. Guardado-Bermúdez et al.

1-4.

Clinical case

-

years of evolution, treated as acid peptic disease. 6 months before the assessment, she presented a lesion of 2 cm in the right hypochondrium, characterised by increased

in an ambulatory manner at the general medicine service

-

Background

-

by putting the patient in ventral decubitus position in order to treat gallbladder disease, more than 2,000 years ago, the

series of 499 patients. During the past century, 70 cases have been reported and 25 of them in the last 50 years. Such tendency of reduction in the appearance of this noso-

-

centuries. We submit the clinical case of a patient start-

PALABRAS CLAVEFístula biliarColecistocutánea; Fistulograma

Fístula colecistocutánea espontánea

ResumenAntecedentes: -sícula biliar con el medio externo a través de la rotura de la pared abdominal; los primeros reportes escritos datan del siglo XVII por Thilesus. Durante los últimos 50 años, se han reportado 25 casos. Caso clínico: -

-

Discusión: -

con colecistopatía litiásica, si bien la clínica de la fístula colecistocutánea espontánea es más que evidente, es indispensable realizar estudios complementarios, como ultrasonido, tomogra-

-

Conclusión: La incidencia de fístulas colecistocutáneas en la actualidad es mínima y parece que -

© 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Fig. 2 Fig. 1

-lous tract (Figs. 4 and 5). An exploration of the bile duct

concluded.

Discussion

the gallbladder to another surface. It is a rare pathology -

they are predominant in female patients under 60 years1,3.

external; the latter present communication to any part of -

tremely rare because, in recent decades, less than 100 cases have been reported in medical literature. In the case

1,2.-

verse etiopathogenesis. Among the causes there are gall-bladder neoplasia, anatomic anomalies and, of course, post-surgery causes. Nevertheless, most cases are associat-

necrosis, bacterial translocation and, eventually, abscesses, -

patient did not have that feature1,3-6.Clinical presentation of spontaneous cholecysto-cutane-

-tion, and biliary colic as a main feature that lasts years. Subsequently, there is also a cutaneous lesion that develops

-ploration and effective examination, can be treated as a

outside (Fig. 1).Subsequently, she returned for assessment at the general

-

the subcutaneous cellular level (Fig. 2).-

greater omentum. A retrograde dissection of the gallbladder

Fig. 5 Fig. 4

Fig. 3 Fistulogram.

64 F. Guardado-Bermúdez et al.

Bibliography

1. de Cirugía General A.C. Academia Mexicana de Cirugía General A.C. Tratado de cirugía general. 2.ª ed. Editorial Manual Mod-erno; 2008. p. 941-948.

2. -tara A, Papadimitriou N, et al. Spontaneous cholecystocutane-

-cal drainage. Ann Ital Chir. 2012;83(1):67-69.

3. Flora HS, Bhattacharya S. Case report spontaneous cholecysto-

4. Ochoa GJR, et al. Fístula colecisto-cutánea espontánea. In-forme de un paciente. Cir Gen. 2002;24(1):53-56.

5. 6. -

plicated by gallstones. Postgrad Med J. 1991;67(786):391-392.7. Cruz JR Jr, Nahas J, de Figueiredo LF. Spontaneous cholecysto-

Sao Paulo Med J. 2006;124(4):234-236.8. Ijaz S, Lidder S, Mohamid W, Thompson HH. Cholecystocutane-

Rep Gastroenterol. 2008;2(1):71-75.9. Dutriaux C, Maillard H, Prophette B, Catala M, Célerier P. Spon-

2005;132(5):467-469.10. Vasanth A, Siddiqui A, O’Donnell K. Spontaneous cholecystocu-

11. -

166-167.12. Khan AA, Azhar MZ, Khan AA, Rasheed A, Khan KN. Spontane-

2005;15(11):726-727.13.

14.

4(3):356-360.15.

Pinto AI, González Pinto I, González González J. Fistula colecis-

de vesícula biliar. Cir Esp. 2013;91(6):396-397. doi:10.1016/ j.ciresp. 2011.12.009.

16.

188-191. DOI: 10.1007/S12262-012-0560-2.17. -

containing multiple gallstones: a case report. Mt Sinai J Med. 2005;72(6):402-404.

18. Spontaneous cholecystocutaneous abscess. JBR-BTR. 2010; 93(4):198-200.

19. Tallon AL, Lopez PM, Molina GD, Bustos JM, Tamayo LM. Chole--

troenterol Hepatol. 2010;33:553-554.20.

tract is consolidated, the effusion of biliar material and cal-5,7-9.

important to conduct extension studies, such as: ultrasound to establish bile duct characteristics, tomography to search

-tablish the lesion aetiology and the presence of bile duct obstructions8,10-13.

-prehensive; even though surgical management is the basis for treatment, conservative management must be consid-

there is evidence of obstruction in the bile duct during

rate is the retrograde endoscopic choliopancreatography.

-apy. The use of endoscopic retrograde cholangiopancrea-tography drains the bile duct, contributing to intraluminal

9,12,14-18.The surgical procedure consists of the cholecystectomy,

-

-cording to the surgeon’s criteria. The preferable approach is usually the conventional; that is to say, by means of a

-

-sion12,14,16,19,20.

Conclusions

-

related pathologies. Even though the efforts of health sys-tems in establishing a prompt diagnosis and treatment for gallbladder diseases has accomplished the reduction of se-

strata of the population there is still a small percentage -

in this text.There must be a preoperative comprehensive assessment

stablish an optimal surgical plan. As regards the approach, abdominal exploration by subcostal means remains as the

and since laparoscopic access is an alternative reserved for

pathology comprehensively via this access.