Asymptomatic macular lesion in the epigastric region: The first symptom of a cholecystocutaneous fistula

Abstract

A 42-year-old female patient was admitted to the clinic due to a right inguinal hernia. During the routine systemic examination, a macular lesion was observed in the epigastric area with a dimension of 15x10 mm. The patient declared that she had noticed the lesion 15 days ago but it did not lead to any inconvenience for her. The patient did not have any systemic disease or was not using any medicine. On the superficial ultrasonography, the wall of the gallbladder was found to be adhered to the linea alba and echos resembling gallstones was also reported over linea alba. The patient is operated. The right inguinal hernia is repaired with Lichtenstein hernioplasty procedure. A wide elliptical incision containing the macula is made in the epigastric region. Multiple calculi were seen in the linea alba with the largest diameter of 7-8 mm. The incision is extended toward the right subcostal region and cholecystectomy is performed. The adherent parts of gallbladder to the fascia are debrided. The operation was terminated by closing the fascia and skin. The majority of cholecystocutaneous fistulae are at the right upper quadrant. Our case was presented because of its slight displacement from the classical localization and it was completely asymptomatic.