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Gallstones Through the Skin? First Report of Cholecystocutaneous Fistula with Gallstones in a Dog
Canadian Veterinary Journal, 2014
Obi Veterinary Education
November 15, 2025
Martina Fabbi, Antonella Volta, Fausto Quintavalla, Elena Zubin, Sabrina Manfredi, Filippo M. Martini, Luciana Mantovani, Mario Tribaudino, Giacomo Gnudi
Background
Spontaneous cholecystocutaneous fistula (CF) is a rare condition involving rupture of the gallbladder through the abdominal wall, resulting in a cutaneous fistula. While known in human medicine, only two cases had been reported in veterinary literature before this study. This report documents the first known case of a cholecystocutaneous fistula in a dog containing multiple gallstones, aiming to highlight diagnostic and therapeutic considerations.
Methods
A 7-year-old Cavalier King Charles Spaniel presented with a chronic, draining thoracic wall lesion discharging fluid and small stones. Diagnostic imaging included ultrasonography and computed tomographic (CT) fistulography, the latter involving direct contrast injection into the draining tract. Surgery was performed for fistula and gallbladder excision. Cultures, histopathology, and compositional analysis of the calculi were conducted.
Results
Ultrasound and CT confirmed a fistulous tract connecting the external thoracic lesion to the gallbladder apex, with multiple radiopaque gallstones present in both the tract and the gallbladder. The largest calculus was lodged in the infundibulum. Surgery confirmed thickened gallbladder walls and adhesions. Cholecystectomy and fistula excision were curative. Cultures grew E. coli sensitive to amoxicillin-clavulanate, which was administered postoperatively. Histopathology confirmed chronic neutrophilic and lymphoplasmacytic cholecystitis. The dog recovered without recurrence over a 6-month follow-up.
Limitations
As a single case report, generalization is limited. Diagnostic imaging and surgical findings were specific to this case, and comparative veterinary data are scarce. Preoperative fistulography using radiography was inconclusive, underscoring the diagnostic value of CT.
Conclusions
Cholecystocutaneous fistula, though rare, should be considered in dogs presenting with chronic draining thoracic or abdominal wall lesions, especially when imaging reveals mineralized structures. CT fistulography proved essential for diagnosis and surgical planning. Cholecystectomy and fistula excision with appropriate antibiotic therapy led to complete resolution. This case expands the differential for chronic dermal fistulae in veterinary patients and provides a diagnostic and therapeutic framework for future cases.
Computed tomographic image at the level of the 7th rib without contrast medium. The dog was positioned in dorsal recumbency. Many radiopaque gallstones are present in the dependent portion of the gallbladder. B — Same computed tomographic image as in (A) with contrast medium: the fistula is filled with contrast medium and a faint hyperdense line is seen within the gallbladder, representing a jet of contrast medium in the lumen (arrowheads). C — Maximum intensity projection ventro-lateral view of the cranial abdomen (the ventral-right part of the body is on the left, the dorsal-left part of the body is on the right): the fistulous tract is filled with contrast medium (arrow) connecting the subcutaneous space (arrowheads) to the gallbladder. D — Volume rendering oblique view of the fistulous tract extending from the 10th intercostal space into the gallbladder (arrowheads). The ventral-right part of the body is on the left; the dorsal-left part of the body is on the right.
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