Clinical image of a cholecystocutaneous fistulation from chronic cholecystitis

A 90-year-old man presented with a 6x7 cm tender, indurated, hard, erythematous lump with a pointing abscess in the right upper abdomen. CT abdomen and pelvis with contrast demonstrated a cholecystocutaneous fistula (CCF) and an inflammatory abdominal wall mass due to chronic gallbladder infection with gallstones. Treatment involved incision and drainage of the anterior abdominal wall under local anaesthesia along with oral co-amoxiclav. CCF is an external biliary fistula connecting the gallbladder to the skin which may arise from untreated gallbladder disease or previous procedures like percutaneous cholecystostomy. Aggressive surgery is generally avoided, especially in elderly and frail patients.