Delayed Spontaneous Passage of Gallstones via Cholecystocutaneous Fistula

An 80-year-old woman presented with acute cholecystitis. On admission she was pyrexic and tachycardic with raised serum inflammatory markers. Computed tomography (CT) confirmed the diagnosis. She had significant morbidity from multiple sclerosis. She had left paresis and was wheelchair-bound. In view of her poor baseline function, the infection was managed with a percutaneous cholecystostomy drain. She recovered well with intravenous antibiotics and drainage of the infected gallbladder. After removal of the cholecystostomy, the drain track failed to heal and subsequently formed a cholecystocutaneous fistula (Figure 1). She managed well after the removal procedure, although the fistula was draining 200–300 mL turbid fluid daily. Two years later she passed 3 gallstones through the fistula, the largest being 5 cm in size (Figure 2). A follow-up CT scan showed an additional stone within the tract (Figure 3). The patient remains asymptomatic, so the plan is to wait for this to pass as well