Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview
Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview
Journal of Medical Case Reports 2009, 3:8626
Published: August 2009
Published: August 2009
Introduction:
Gallbladder perforation is common and occurs in 6 to 40% of laparoscopic cholecystectomy procedures. In up to a third of these cases, stones are not retrieved and complications can arise many years post-operatively. Diagnosis can be difficult and patients may present to many specialties within medicine and surgery. We seek to present our case and review the literature on prevention and management of “lost” stones.
Case presentation:
Our patient is a 77-year-old woman who presented to the urology clinic with a loin abscess that developed five years after laparoscopic cholecystectomy. Radiological studies showed retained abdominal gallstones and an associated abscess formation. These were drained under ultrasound guidance on several occasions and the patient now suffers from chronic sinusitis. Due to her age and comorbidities, she has declined definitive surgical intervention to remove the stones.
Conclusion:
Gallbladder perforation during laparoscopic cholecystectomy is a reasonably common problem and may result in spilled and lost gallstones. Though uncommon, these stones may lead to early or late complications, which can be a diagnostic challenge and cause significant morbidity to the patient. Clear documentation and patient awareness of lost gallstones is of utmost importance, as this may enable prompt recognition and treatment of any complications.
Introduction
In the current era of minimally invasive surgery, laparoscopic cholecystectomy has become the gold standard for the surgical treatment of symptomatic gallstones. However, with the increase in the number of laparoscopic operations performed, there has also been a noticeable increase in the number of complications specific to these procedures. Gallstones can be spilled during an open cholecystectomy, but these stones are eliminated usuallythrough direct removal, copious irrigation and mopping with laparotomy sponges. In laparoscopic procedures, these techniques are more difficult or unavailable and so stones can disappear from view and can become “lost”. Studies show that the incidence of spilled gallstonesduring laparoscopic cholecystectomy accounts for 6 to 40% of procedures performed, while 13 to 32% of such operations result in lost stones 1,2. Complications from stones that are left within the peritoneal cavity can cause unusual but significant morbidity.
References:
- Bhatti CS, Tamijmarane A, Bramhall SR: A tale of three spilled gallstones: one liver mass and two abscesses. Dig Surg 2006, 23:198-200.
- Yadav RK, Yadav VS, Garg P et al: Gallstone expectoration following laparoscopic cholecystectomy. Indian J Chest Dis Allied Sci 2002, 44:133-135.
- Frola C, Cannici F, Cantoni S et al: Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy. Br J Radiol 1999, 72:201-203.
- Hand AH, Self ML, Dunn E: Abdominal wall abscess formation two years after laparoscopic cholecystectomy. JSLS 2006, 10:105-107.
- Zehetner J, Shamiyeh A, Wayand W: Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007, 193:73-78.
- Chowbey PK, Bagchi N, Sharma A et al: Abdominal Wall Sinus: An unusual presentation of spilled gallstone. J Laparoendosc Adv Surg Tech A 2006, 16:613-615.
- Patterson EJ, Nagy AG: Don’t cry over spilled stones? Complications of gallstones spilled during laparoscopic cholecystectomy: case report and literature review. Can J Surg 1997, 40:300-304.
- Karabulut N, Tavasli B, Kirogˇlu Y: Intra-abdominal spilled gallstones simulating peritoneal metastasis: CT and MR imaging features (2008: 1b). Eur Radiol 2008, 18:851-854.
