Spontaneous external biliary fistulae-is it a revisit?

Spontaneous biliary fistulae are encountered, not very rarely, in one’s surgical practice. These fistulae are of three types, Internal, External and Combined. Internal spontaneous biliary fistulae are commonest. External fistulae could be spontaneous or because of Therapeutic, Iatrogenic or Traumatic reasons and are very very rare. Spontaneous cholecystocutaneos fistula (SCCF), secondary to calculous cholecystitis is an extremely rare presentation in the present day scenario. It used to be quite common before the year 1900, but is very rare now because of better management of cholecystitis and cholelithiasis. SCCF is, usually, a complication of neglected chronic cholelithiasis. This is seldom seen today because of the early diagnosis and better management made feasible by ultrasound as first line investigation, broad spectrum antibiotics, and effective surgical management of biliary tract diseases. We hereby present two reports including a very rare case of 35 years old female patient presenting in the outpatient department with the multiple stones carefully preserved, which she had been extruding through the fistulous opening in the umbilicus, for the last one year. She was investigated and was operated for the same condition. Though the entity is very rare yet clinician should keep this condition in mind while examining any case of chronic discharging sinus or fistula on the abdominal wall, particularly the wound extruding stones in which case the diagnosis is self-revealing. Though the early diagnosis and improvement in the management of gallbladder disease has improved tremendously yet the possibility of this condition arising mostly from the neglected gallbladder disease should always be kept in mind as such cases are again being reported from all over the world. In the absence of positive history of expelling stones the diagnosis can be confirmed by computerized tomogram [CT] fistulography. The literature of this extremely rare and interesting entity is also reviewed in this article.