Spontaneous cholecystocutaneous fistula as a rare presentation of advanced gallbladder adenocarcinoma: a case report and review of the literature
Year: 2026
Type: article
Study design: Case Report
Abstract: Introduction and importance: Spontaneous cholecystocutaneous fistula (SCCF) is an exceptionally rare complication of gallbladder disease in the modern era and is only rarely associated with gallbladder carcinoma. Its atypical clinical presentation may delay diagnosis and treatment. Case presentation: A 79-year-old woman from a rural area presented with a fistulized abdominal wall abscess evolving for 3 months. Her medical history included type two diabetes mellitus, left lower-limb amputation due to diabetic foot disease, and thrombectomy for right popliteal artery occlusion. Physical examination revealed an indurated cutaneous fistula with inflammatory changes over the right flank. Laboratory investigations showed mild anemia and elevated inflammatory markers, while liver function tests were within normal limits. Contrast-enhanced thoraco-abdomino-pelvic computed tomography demonstrated irregular thickening of the gallbladder infiltrating hepatic segment V with omental extension, associated with an air-fluid collection that communicated with the abdominal wall and peritoneal cavity, consistent with a SCCF. Histopathological examination confirmed advanced gallbladder adenocarcinoma. Discussion: SCCF has become extremely uncommon owing to advances in imaging, antibiotic therapy, and early surgical management of biliary disease. While most reported cases are secondary to neglected cholelithiasis, fistulization caused by gallbladder carcinoma remains exceptional. Chronic inflammation, tumor necrosis, and direct local invasion are considered the principal mechanisms involved. This unusual presentation may mimic a chronic abdominal wall abscess, potentially delaying recognition of the underlying malignancy. Conclusion: SCCF may represent a rare presenting manifestation of advanced gallbladder adenocarcinoma. Underlying malignancy should be considered in elderly patients presenting with atypical abdominal wall abscesses or biliary-cutaneous fistulas. Cross-sectional imaging and histopathological examination are essential for establishing the diagnosis and guiding management.
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7225702405