Cholecystocutaneous Fistula
No Results
No Results
processing….
A fistula is an epithelium-lined tract between two epithelium-lined surfaces. Biliary fistulae can be internal or external. External biliary fistulae, in turn, can be further subdivided based on etiology into spontaneous, therapeutic, traumatic, and iatrogenic fistulae.
A cholecystocutaneous fistula is an abnormal epithelial tract that allows communication between the gallbladder and the skin. This communication can be either spontaneous (often a complication of neglected gallstone disease) or deliberate (as in the case of a therapeutic percutaneous cholecystostomy used to treat cholecystitis or empyema of the gallbladder, which is generally reserved for patients unfit for surgical intervention).
Spontaneous cholecystocutaneous fistula is a rare condition that has become even rarer because of prompt diagnosis and expedient surgical intervention for gallstones. Although most spontaneous cholecystocutaneous fistulae are related to underlying gallstones, they may also, in very rare cases, be related to underlying adenocarcinoma of the gallbladder. [1, 2]
Spontaneous cholecystocutaneous fistula was first described by Thilesus in 1670. [3] Before 1900, three large series were published in quick succession by Courvoisier in 1890 (169 of 499 cases of gallbladder perforation), Naunyn in 1896 (184 cases), and Bonnet in 1897 (122 cases). [4, 5, 6, 7] These large case series reflected the state of surgical care at the time. However, with subsequent improvements in surgical care, the incidence of spontaneous cholecystocutaneous fistula has declined dramatically, with most cases now originating from developing countries or from elderly, institutionalized patients in developed countries.
The cystic duct or gallbladder is almost always obstructed in patients with spontaneous cholecystocutaneous fistula. In the presence of obstruction, the gallbladder distends and the pressure within rises, impairing the vascular supply. The obstruction and impaired blood supply result in inflammation and may cause focal areas of necrosis. This inflammatory process is typically insidious and recurrent. Surrounding structures wall off the focal area of necrosis. Perforation of the gallbladder may occur, causing a localized cholecystic abscess. In an attempt to discharge this abscess, a fistula may therefore form between the gallbladder and the duodenum, colon, or abdominal wall.
In spontaneous cholecystocutaneous fistula, the abscess is walled off by the abdominal wall and progressively penetrates it. The fistula usually occurs via the fundus of the gallbladder, as this is the farthest from the cystic artery and most likely to be affected in inflammation-caused ischemia. The cholecystic abscess may initially cause a tender area in the abdominal wall and spontaneously rupture, forming a fistula with drainage onto the skin.
Because of the anatomy and position of the gallbladder, the gallbladder is more likely to adhere to neighboring viscera, such as the duodenum and colon, forming cholecystoduodenal fistula that predisposes to gallstone ileus or cholecystocolonic fistula. As with cholecystocutaneous fistula, the incidence of cholecystoduodenal fistula has also declined because of expeditious surgical intervention.
This condition is invariably a complication of neglected gallstone disease, though isolated case reports have described spontaneous cholecystocutaneous fistula due to carcinoma of the gallbladder and acalculous cholecystitis. [8] Carcinoma of the gallbladder can cause cystic duct obstruction, which leads to inflammation in a manner similar to that of gallstones. [9]
In addition, retained gallstones following laparoscopic cholecystectomy may cause biliary fistula or abdominal wall sinuses. This occurs because gallstones can harbor bacteria, which may form a localized abscess with fistula or sinus in an attempt to discharge the foreign body. [10, 11] However, this complication of cholecystectomy is relatively uncommon despite the relatively common occurrence of stone spillage. Some authors recommend the liberal use of retrieval bags during surgery to avoid stone spillage and subsequent complications of retained stones. [12]
Salmonella typhi, which has a predilection for the gallbladder, can cause chronic cholecystitis and may predispose the patient to spontaneous cholecystocutaneous fistula. [13] Polyarteritis nodosa with gallbladder vasculitis and steroid use causing immunosuppression also may be associated with the condition. [13]
Spontaneous cholecystocutaneous fistula is rare. Since the advent of surgical treatment of gallbladder calculous disease, the incidence of cholecystocutaneous fistula has reduced dramatically. Between 1890 and 1949, only 37 cases were identified in the published literature. [7] A literature review of cases published between 1961 and 2013 identifies just over 50 cases (see Table 1 below). In a retrospective review in Greece, of 210 cases of external biliary fistulae over a 22-year period, only 1 was due to spontaneous cholecystocutaneous fistula. [14]
Table 1. Case Reports of Cholecystocutaneous Fistula From 1961 to 2013 (Open Table in a new window)
Author(s)
Year Published
Number of Cases
Country of Origin
Sodhi et al [15]
2012
1
India
Ozdemir et al [16]
2012
1
Turkey
Andersen and Friis-Andersen [17]
2012
1
Denmark
Ioannidis et al [18]
2012
1
Italian
Baty et al [19]
2011
1
Australia
Cheng et al [20]
2011
1
Taiwan
Khan et al [21]
2011
1
Ireland
Gordon et al [22]
2011
1
United States of America
Sayed et al [23]
2010
1
United Kingdom
Pezzilli et al [24]
2010
1
Italy
Metsemakers et al [25]
2010
1
Belgium
Tallon Aquilar et al [26]
2010
1
Spain
Hawari et al [27]
2010
1
United Kingdom
Gandhi et al [28]
2009
1
New Zealand
Murphy et al [29]
2008
1
United Kingdom
Ijaz et al [30]
2008
1
United Kingdom
Chatterjee et al [31]
2007
1
India
Malik et al [32]
2007
1
United Kingdom
Nagral et al [33]
2007
1
India
Marwah et al [34]
2007
1
India
Shrestha et al [35]
2006
1
United Kingdom
Cruz et al [36]
2006
1
Brazil
Salvador-Izquierdo et al [37]
2006
1
Spain
Yuceyar et al [38]
2005
1
Turkey
Khan et al [39]
2005
1
Saudi Arabia
Dutriaux et al [40]
2005
1
France
Gossage et al [41]
2004
1
United Kingdom
Vasanth et al [42]
2004
1
United States of America
Mathonnet et al [43]
2002
1
France
Chang et al [44]
2002
1
Taiwan
Flora et al [45]
2001
1
United Kingdom
Ramos Rincon et al [46]
2001
1
Spain
Nicholson et al [47]
1999
1
United States of America
Avital et al [48]
1998
1
Israel
Kumar [49]
1998
1
United States of America
Andley et al [50]
1996
1
India
Birch et al [51]
1991
1
United Kingdom
Carragher et al [52]
1990
1
United Kingdom
Rosario et al [53]
1990
1
United States of America
Sevonius et al [54]
1988
1
Sweden
Gibson et al [55]
1987
1
United Kingdom
Bilanovic et al [56]
1987
1
Croatia
Tuna et al [57]
1986
1
United States of America
Hakaim et al [58]
1986
1
United States of America
Rye et al [59]
1985
1
Denmark
Kulicki et al [60]
1984
1
Poland
Davies et al [61]
1984
1
United Kingdom
Abril et al [62]
1984
1
United States of America
Nayman [63]
1983
1
Australia
Ulreich et al [64]
1983
1
United States of America
Hoffman et al [65]
1982
1
United States of America
Fitchett et al [66]
1970
1
United States of America
Callen [67]
1979
1
United States of America
Orr [68]
1979
1
Australia
The declining incidence has been attributed to prompt diagnosis, availability of antibiotics, and early surgical intervention for cholecystitis and empyema (see Pathophysiology). The decline is further confirmed by the availability of large series published before the 20th century, in contrast to the more recent literature, which consists mainly of individual case reports.
Although patients with cholecystocutaneous fistula tend to be elderly, the condition has been reported in patients in their third decade of life. Similarly, young patients are likely to have neglected their symptoms for a period or have neuropathy that causes altered sensation. [65] Women are also affected more than men, reflecting the higher incidence of cholelithiasis and cholecystitis among women.
Prognosis is generally good. However, given that most patients with this condition are elderly, potential coexisting medical problems may complicate surgical intervention.
Malignant change in the fistulous tract is rare and generally occurs only after 10-20 years. [12]
Mathew G, Bhimji SS. Fistula, cholecystocutaneous. Treasure Island, FL: StatPearls Publishing; 2017 Jun. [Full Text].
Micu BV, Andercou OA, Micu CM, Militaru V, Jeican II, Bungărdean CI, et al. Spontaneous cholecystocutaneous fistula as a primary manifestation of gallbladder adenocarcinoma associated with gallbladder lithiasis – case report. Rom J Morphol Embryol. 2017. 58 (2):575-583. [Medline].
Horhammer Cl. Ueberestraperitonealeperforatio der Gallenblase. Munchener Medizinische Wochenschrift. October 1916. 10:1451-1452.
Courvoisier L. Pathologie and Chirurgie der Gallenwege. FCW Vogel: Leipzig, Germany; 1890.
Naunyn B. Ulcerative affections of the biliary passage and fistula formation. A Treatise on Cholelithiasis. New Syndenham Society; (English version 1896). New Syndenham Society: 1892. 138-151.
Bonnet. Fistulebiliairecutanee. Lyon Med. 1897. 85:
Henry CL, Orr TG. Spontaneous external biliary fistulas. Surgery. 1949. 26(4):641-646.
Chang SS, Lu CL, Pan CC, et al. Spontaneous cholecystocutaneous fistula presenting with a cellulitis and portal vein thrombosis. J Clin Gastroenterol. 2002 Jan. 34(1):99-100. [Medline].
Vasanth A, Siddiqui A, O’Donnell K. Spontaneous cholecystocutaneous fistula. South Med J. 2004 Feb. 97(2):183-5. [Medline].
Lau MW, Hall CN, Brown TH. Biliary-cutaneous fistula: an uncommon complication of retained gallstones following laparoscopic cholecystectomy. Surg Laparosc Endosc. 1996 Apr. 6(2):150-1. [Medline].
Weiler H, Grandel A. Postoperative fistula of the abdominal wall after laparascopic cholecystectomy due to lost gallstones. Eur J Ultrasound. 2002 Jun. 15(1-2):61-3. [Medline].
Shrestha BM, Wyman A. Cholecystocolocutaneous fistula: a case report. Hepatobiliary Pancreat Dis Int. 2006 Aug. 5(3):462-4. [Medline].
Birch BR, Cox SJ. Spontaneous external biliary fistula uncomplicated by gallstones. Postgrad Med J. 1991 Apr. 67(786):391-2. [Medline]. [Full Text].
Dadoukis J, Prousalidis J, Botsios D, et al. External biliary fistula. HPB Surg. 1998. 10(6):375-7. [Medline]. [Full Text].
Sodhi K, Athar M, Kumar V, Sharma ID, Husain N. Spontaneous cholecysto-cutaneous fistula complicating carcinoma of the gall bladder: a case report. Indian J Surg. 2012 Apr. 74(2):191-3. [Medline].
Ozdemir Y, Yucel E, Sucullu I, Filiz I, Gulec B, Akin ML. Spontaneous cholecystocutaneous fistula as a rare complication of gallstones. Bratisl Lek Listy. 2012. 113(7):445-7. [Medline].
Andersen P, Friis-Andersen H. [Spontaneous cholecystocutaneous fistula presenting in the right breast]. Ugeskr Laeger. 2012 Apr 30. 174(18):1235-6. [Medline].
Ioannidis O, Paraskevas G, Kotronis A, Chatzopoulos S, Konstantara A, Papadimitriou N. Spontaneous cholecystocutaneous fistula draining from an abdominal scar from previous surgical drainage. Ann Ital Chir. 2012 Jan-Feb. 83(1):67-9. [Medline].
Batty L, Freeman L, Dubrava Z. A spontaneous cholecystocutaneous fistula. ANZ J Surg. 2011 Nov. 81(11):847. [Medline].
Cheng HT, Wu CI, Hsu YC. Spontaneous cholecystocutaneous fistula managed with percutaneous transhepatic gallbladder drainage. Am Surg. 2011 Dec. 77(12):E285-6. [Medline].
Khan A, Rajendran S, Baban C, Murphy M, O’Hanlon D. Spontaneous cholecystocutaneous fistula. BMJ Case Rep. 2011 Jul 20. 2011:[Medline].
Gordon PE, Miller DL, Rattner DW, Conrad C. Image of the month. Cholecystocutaneous fistula (Jean-Louis Petit phlegmon). Arch Surg. 2011 Apr. 146(4):487-8. [Medline].
Sayed L, Sangal S, Finch G. Spontaneous cholecystocutaneous fistula: a rare presentation of gallstones. J Surg Case Rep. 2010 Jul 1. 2010 (5):5. [Medline]. [Full Text].
Pezzilli R, Barakat B, Corinaldesi R, Cavazza M. Spontaneous Cholecystocutaneous Fistula. Case Rep Gastroenterol. 2010 Sep 15. 4(3):356-360. [Medline]. [Full Text].
Metsemakers WJ, Quanten I, Vanhoenacker F, Spiessens T. Spontaneous cholecystocutaneous abscess. JBR-BTR. 2010 Jul-Aug. 93(4):198-200. [Medline].
Tallon Aguilar L, Lopez Porras M, Molina Garcia D, Bustos Jimenez M, Tamayo Lopez MJ. [Cholecystocutaneous fistula: a rare complication of gallstones]. Gastroenterol Hepatol. 2010 Aug-Sep. 33(7):553-4. [Medline].
Hawari M, Wemyss-Holden S, Parry GW. Recurrent chest wall abscesses overlying a pneumonectomy scar: an unusual presentation of a cholecystocutaneous fistula. Interact Cardiovasc Thorac Surg. 2010 May. 10(5):828-9. [Medline].
Gandhi J, Gandhi N. Abdominal wall abscess: more than meets the eye. BMJ Case Rep. 2010. 2010:[Medline]. [Full Text].
Murphy JA, Vimalachandran CD, Howes N, Ghaneh P. Anterior abdominal wall abscess secondary to subcutaneous gallstones. Case Rep Gastroenterol. 2008 Jul 9. 2(2):219-23. [Medline]. [Full Text].
Ijaz S, Lidder S, Mohamid W, Thompson HH. Cholecystocutaneous fistula secondary to chronic calculous cholecystitis. Case Rep Gastroenterol. 2008 Mar 11. 2(1):71-5. [Medline]. [Full Text].
Chatterjee S, Choudhuri T, Ghosh G, Ganguly A. Spontaneous cholecystocutaneous fistula in a case of chronic colculous cholecystitis–a case report. J Indian Med Assoc. 2007 Nov. 105(11):644, 646, 656. [Medline].
Malik AH, Nadeem M, Ockrim J. Complete laparoscopic management of cholecystocutaneous fistula. Ulster Med J. 2007 Sep. 76(3):166-7. [Medline]. [Full Text].
Nagral SS, Rao RG. Spontaneous cholecystocutaneous fistula. Bombay Hosp J. 2007 Oct. 49 (4):[Full Text].
Marwah S, Godara R, Sandhu D, Karwasra R. Spontaneous gallbladder perforation presenting as abdominal wall abscess. Internet J Surg. 2006. 12 (2):1-3. [Full Text].
Shrestha BM, Wyman A. Cholecystocolocutaneous fistula: a case report. Hepatobiliary Pancreat Dis Int. 2006 Aug. 5(3):462-4. [Medline].
Cruz RJ Jr, Nahas J, de Figueiredo LF. Spontaneous cholecystocutaneous fistula: a rare complication of gallbladder disease. Sao Paulo Med J. 2006 Jul 6. 124(4):234-6. [Medline].
Salvador-Izquierdo R, Gimeno-Solsona F. [Spontaneous cholecystocutaneous fistula in the ederly]. Med Clin (Barc). 2006 Sep 9. 127(9):359. [Medline].
Yuceyar S, Erturk S, Karabicak I, Onur E, Aydogan F. Spontaneous cholecystocutaneous fistula presenting with an abscess containing multiple gallstones: a case report. Mt Sinai J Med. 2005 Nov. 72(6):402-4. [Medline].
Khan AA, Azhar MZ, Khan AA, Rasheed A, Khan KN. Spontaneous cholecystocutaneous fistula. J Coll Physicians Surg Pak. 2005 Nov. 15(11):726-7. [Medline].
Dutriaux C, Maillard H, Prophette B, Catala M, Célerier P. [Spontaneous cholecystocutaneous fistula]. Ann Dermatol Venereol. 2005 May. 132(5):467-9. [Medline].
Gossage J, Forshaw M, Stephenson J, Mason R. Spontaneous cholecysto-cutaneous fistula. J Surg. 2004. 2 (1):52-3. [Full Text].
Vasanth A, Siddiqui A, O’Donnell K. Spontaneous cholecystocutaneous fistula. South Med J. 2004 Feb. 97(2):183-5. [Medline].
Mathonnet M, Maisonnette F, Gainant A, Cubertafond P. [Spontaneous cholecystocutaneous fistula: natural history of biliary cholecystitis]. Ann Chir. 2002 May. 127(5):378-80. [Medline].
Chang SS, Lu CL, Pan CC, et al. Spontaneous cholecystocutaneous fistula presenting with a cellulitis and portal vein thrombosis. J Clin Gastroenterol. 2002 Jan. 34(1):99-100. [Medline].
Flora HS, Bhattacharya S. Spontaneous cholecystocutaneous fistula. HPB (Oxford). 2001. 3(4):279-80. [Medline]. [Full Text].
Ramos Rincon JM, Fernandez Frias A, Costa Navarro D, et al. [Spontaneous bilio-cutaneous fistula. A rare clinical entity]. Gastroenterol Hepatol. 2001 Oct. 24(8):411-2. [Medline].
Nicholson T, Born MW, Garber E. Spontaneous cholecystocutaneous fistula presenting in the gluteal region. J Clin Gastroenterol. 1999 Apr. 28(3):276-7. [Medline].
Avital S, Greenberg R, Goldwirth M, Werbin N, Skornik Y. A spontaneous discharging wound on the abdominal wall. Postgrad Med J. 1998 Aug. 74(874):505-6. [Medline]. [Full Text].
Kumar SS. Laparoscopic management of a cholecystocutaneous abscess. Am Surg. 1998 Dec. 64(12):1192-4. [Medline].
Andley M, Biswas RS, Ashok S, Somshekar G, Gulati SM. Spontaneous cholecystocutaneous fistula secondary to calculous cholecystitis. Am J Gastroenterol. 1996 Aug. 91(8):1656-7. [Medline].
Birch BR, Cox SJ. Spontaneous external biliary fistula uncomplicated by gallstones. Postgrad Med J. 1991 Apr. 67(786):391-2. [Medline]. [Full Text].
Carragher AM, Jackson PR, Panesar KJ. Subcutaneous herniation of gall-bladder with spontaneous cholecystocutaneous fistula. Clin Radiol. 1990 Oct. 42(4):283-4. [Medline].
Rosario PG, Gerst PH, Prakash K, Katter H. Cholecystocutaneous fistula: an unusual presentation. Am J Gastroenterol. 1990 Feb. 85(2):214-5. [Medline].
Sevonius D, Jóhannesson E. [Gluteal abscess shown to be a cholecystocutaneous fistula]. Lakartidningen. 1988 Mar 23. 85(12):1061. [Medline].
Gibson TC, Howat JM. Cholecystocutaneous fistula. Br J Clin Pract. 1987 Oct. 41(10):980-2. [Medline].
Bilanovic D, Colovic R. [Spontaneous cholecystocutaneous fistula]. Acta Chir Iugosl. 1987. 34(1):65-8. [Medline].
Tuna IC, Maizel S, O’Connor M, Humphrey EW. Simultaneous cholecystocutaneous and cholecystoduodenal fistulae. Minn Med. 1986 Feb. 69(2):77-8. [Medline].
Hakaim AG, Vogt DP. Spontaneous cholecystocutaneous fistulas. Cleve Clin Q. 1986 Winter. 53(4):363-5. [Medline].
Rye B, Jorgensen U. [Spontaneous cholecystocutaneous fistula]. Ugeskr Laeger. 1985 Jul 15. 147(29):2305-6. [Medline].
Kulicki M. [Case of cholecystocutaneous fistula]. Wiad Lek. 1984 Jun 15. 37(12):955-7. [Medline].
Davies CJ, Fontaine CJ. Spontaneous cholecysto-umbilical fistula. Br J Radiol. 1984 Nov. 57(683):1034-6. [Medline].
Abril A, Ulfohn A. Spontaneous cholecystocutaneous fistula. South Med J. 1984 Sep. 77(9):1192-3. [Medline].
Nayaman J. Empyema necessitatis of the gall-bladder. Med J Aust. 1963 Mar 23. 1:429-30. [Medline].
Ulreich S, Henken EM, Levinson ED. Imaging in the diagnosis of cholecystocutaneous fistulae. J Can Assoc Radiol. 1983 Mar. 34(1):39-41. [Medline].
Hoffman L, Beaton H, Wantz G. Spontaneous cholecystocutaneous fistula: a complication of neglected biliary tract disease. J Am Geriatr Soc. 1982 Oct. 30(10):632-4. [Medline].
Fitchett CW. Spontaneous external biliary fistula. Va Med Mon (1918). 1970 Sep. 97(9):538-43. [Medline].
Callen JP. Cholecystocutaneous fistula. Int J Dermatol. 1979 Jan-Feb. 18(1):63-4. [Medline].
Orr KB. Spontaneous external biliary fistula. Aust N Z J Surg. 1979 Oct. 49(5):584-5. [Medline].
Davies MG, Tadros E, Gaine S, McEntee GP, Gorey TF, Hennessy TP. Combined internal and external biliary fistulae treated by percutaneous cholecystlithotomy. Br J Surg. 1989 Dec. 76(12):1258. [Medline].
Gifford J, Saltzstein SL, Barone RM. Adenocarcinoma occurring in association with a chronic sinus tract and biliary fistula. Cancer. 1981 Apr 15. 47(8):2093-7. [Medline].
Author(s)
Year Published
Number of Cases
Country of Origin
Sodhi et al [15]
2012
1
India
Ozdemir et al [16]
2012
1
Turkey
Andersen and Friis-Andersen [17]
2012
1
Denmark
Ioannidis et al [18]
2012
1
Italian
Baty et al [19]
2011
1
Australia
Cheng et al [20]
2011
1
Taiwan
Khan et al [21]
2011
1
Ireland
Gordon et al [22]
2011
1
United States of America
Sayed et al [23]
2010
1
United Kingdom
Pezzilli et al [24]
2010
1
Italy
Metsemakers et al [25]
2010
1
Belgium
Tallon Aquilar et al [26]
2010
1
Spain
Hawari et al [27]
2010
1
United Kingdom
Gandhi et al [28]
2009
1
New Zealand
Murphy et al [29]
2008
1
United Kingdom
Ijaz et al [30]
2008
1
United Kingdom
Chatterjee et al [31]
2007
1
India
Malik et al [32]
2007
1
United Kingdom
Nagral et al [33]
2007
1
India
Marwah et al [34]
2007
1
India
Shrestha et al [35]
2006
1
United Kingdom
Cruz et al [36]
2006
1
Brazil
Salvador-Izquierdo et al [37]
2006
1
Spain
Yuceyar et al [38]
2005
1
Turkey
Khan et al [39]
2005
1
Saudi Arabia
Dutriaux et al [40]
2005
1
France
Gossage et al [41]
2004
1
United Kingdom
Vasanth et al [42]
2004
1
United States of America
Mathonnet et al [43]
2002
1
France
Chang et al [44]
2002
1
Taiwan
Flora et al [45]
2001
1
United Kingdom
Ramos Rincon et al [46]
2001
1
Spain
Nicholson et al [47]
1999
1
United States of America
Avital et al [48]
1998
1
Israel
Kumar [49]
1998
1
United States of America
Andley et al [50]
1996
1
India
Birch et al [51]
1991
1
United Kingdom
Carragher et al [52]
1990
1
United Kingdom
Rosario et al [53]
1990
1
United States of America
Sevonius et al [54]
1988
1
Sweden
Gibson et al [55]
1987
1
United Kingdom
Bilanovic et al [56]
1987
1
Croatia
Tuna et al [57]
1986
1
United States of America
Hakaim et al [58]
1986
1
United States of America
Rye et al [59]
1985
1
Denmark
Kulicki et al [60]
1984
1
Poland
Davies et al [61]
1984
1
United Kingdom
Abril et al [62]
1984
1
United States of America
Nayman [63]
1983
1
Australia
Ulreich et al [64]
1983
1
United States of America
Hoffman et al [65]
1982
1
United States of America
Fitchett et al [66]
1970
1
United States of America
Callen [67]
1979
1
United States of America
Orr [68]
1979
1
Australia
Cherry Ee Peck Koh, MBBS, MS, FRACS Colorectal and General Surgeon, Royal Prince Alfred Hospital, Australia
Cherry Ee Peck Koh, MBBS, MS, FRACS is a member of the following medical societies: Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.
David Merenstein, MBBS, FRACS Consulting Staff, General and Endocrine Surgery, Department of Surgery, Monash Medical Centre, Faculty of Medicine, Nursing and Health Services; Consulting Staff, Sandringham and District Hospital, William Angliss Hospital and West Gippsland Hospital
David Merenstein, MBBS, FRACS is a member of the following medical societies: Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.
Simon Roger Berry, MBBS General, UGI, and HPB Surgeon, Surgical Consulting Group, Cabrini Hospital, Australia
Simon Roger Berry, MBBS is a member of the following medical societies: International Hepato-Pancreato-Biliary Association, Australian Medical Association, Australian Medical Association, Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology
Disclosure: Received none from RFA Medical for director; Received none from MRC Biotec for director.
John Geibel, MD, DSc, MSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow
John Geibel, MD, DSc, MSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.
Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine
Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association
Disclosure: Nothing to disclose.
Cholecystocutaneous Fistula
Research & References of Cholecystocutaneous Fistula|A&C Accounting And Tax Services
Source
0 Comments