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Special Feature
April 2011April 18, 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(4):488. doi:10.1001/archsurg.2011.66-b

Spontaneous cholecystocutaneous fistulas have been reported since Thilesus in 1670.1 In 1890, 169 cases of spontaneous biliary fistula were reported by Courvosier,2 36 cases were reported by Henry and Ort in 1949,2 and only 16 cases were reported over the last 50 years.3 Presently, incidence is greatest in women older than 60 years or men younger than 24 years.1 Cholecystocutaneous fistulas occur as a result of the persistent inflammation of a perforated gallbladder, trauma, iatrogenic causes,4 neglected chronic cholecystitis,4 calculus cholelithiasis, or, infrequently, carcinomas.3 Fistulas develop primarily at the fundus of the gallbladder and can communicate with the abdominal parieties, duodenum, colon, stomach, gluteal region,4,5 chest wall, or thigh.1