Fever after Percutaneous Cholecystostomy Catheter Removal: Gallstone Extrusion Through a Persistent Cholecystostomy Tract

Gallstone extrusion through a persistent percutaneous cholecystostomy tract is an unusual complication following catheter removal.We report a 72-year-old institutionalised male who re-attended the emergency department with three days of fever without abdominal pain, tenderness, leukocytosis, or liver biochemical abnormalities.Six days earlier, a partially dislodged percutaneous cholecystostomy catheter, inserted six months prior for acute gangrenous cholecystitis, was removed after unsuccessful exchange while he remained clinically well.Two days before re-attendance, the catheter site was unremarkable.On re-attendance, catheter site inspection revealed extrusion of gallstone-like material.Computed tomography demonstrated acute-on-chronic cholecystitis with an inflamed tract extending from the gallbladder fundus towards the abdominal wall.Gross examination identified gallstones, and fluoroscopic contrast injection demonstrated communication between the cutaneous tract and gallbladder.A new percutaneous cholecystostomy catheter was advanced through the tract for drainage and source control.Given the prolonged catheterisation, short interval after catheter removal, and fluoroscopic findings, persistence of the mature tract was considered more likely than a new cholecystocutaneous fistula, although the latter could not be excluded.This complication may present predominantly with fever and few localising findings.In patients with limited history, reassessment of the previous procedural site may provide an important diagnostic clue and facilitate timely management.