Incidental discovery of an asymptomatic cholecystocutaneous fistula in an elderly patient undergoing emergency laparotomy

Introduction: Cholecystocutaneous fistulas (CCFs) are extremely rare in the modern era and almost always symptomatic. Case presentation: An 88-year-old woman underwent emergency laparotomy for cecal perforation with fecal peritonitis. Intraoperatively, a completely asymptomatic CCF containing a 3.2 cm subcutaneous gallstone – without any external skin opening or previous drainage – was discovered incidentally. Simultaneous cholecystectomy and fistula tract excision were performed after source control, adding approximately 25 minutes to the procedure. Recovery was uneventful, and the patient was discharged on postoperative day 9. Discussion: This appears to be the first documented case of a truly asymptomatic CCF without cutaneous breach discovered incidentally during surgery for another pathology. Conclusion: Thorough intraoperative exploration can reveal silent pathology, and opportunistic definitive treatment is safe and beneficial when the patient is stabilized and additional operative time is minimal. Compliance This case report complies with the Revised SCARE 2025 criteria.