Migration of a Giant Gallstone Through a Therapeutic Cholecystocutaneous Fistula: A Case Report

Percutaneous cholecystostomy tubes (PCTs) are employed in the management of acute cholecystitis in patients unfit for surgery and may be utilised to create a temporary or permanent therapeutic cholecystocutaneous fistula. While spontaneous passage of small gallstones through such fistulae has been described, the migration of a giant gallstone (≥5 cm) has not previously been reported. We present a case involving an 82-year-old woman with a gallstone measuring 65x40 mm that had traversed a cholecystocutaneous fistula and become lodged subcutaneously. The stone was successfully extracted through incision of the fistula tract, resulting in significant resolution of her presenting symptoms. To our knowledge, this is the first reported case of a giant gallstone migrating through a cholecystocutaneous fistula. CT imaging may substantially underestimate the solid content of a peri-fistular collection. Clinical examination findings should therefore guide surgical decision-making when imaging is equivocal. Giant gallstone migration is a rare but clinically significant complication of permanent cholecystocutaneous fistulae, of which surgeons should be cognisant.