1
|
Nagata K, Fujikawa T, Oka S, Osaki T. A Case of Intractable Lung Abscess Following Dropped Gallstone-Induced Subphrenic Abscess: A Rare Postoperative Complication Caused by Dropped Gallstone During Laparoscopic Cholecystectomy. Cureus 2022; 14:e27491. [PMID: 36060363 PMCID: PMC9425714 DOI: 10.7759/cureus.27491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/29/2022] Open
Abstract
Dropped gallstones into the abdominal cavity due to perforation of the gallbladder occasionally occur during laparoscopic cholecystectomy. Abscess formation caused by residual gallstones is one of the late postoperative complications after laparoscopic cholecystectomy. Most of them are intra-abdominal abscesses; however formation of intra-thoracic abscesses, in particular, lung abscess, is less described, and surgery for an intra-thoracic abscess is rarely performed. We describe a case of intractable lung abscess following dropped gallstone-induced subphrenic abscess caused by a residual gallstone after laparoscopic cholecystectomy.
Collapse
|
2
|
Kendera W, Shroff N, Al-Jabbari E, Barghash M, Bagherpour A, Bhargava P. "Target sign" from dropped gallstones after laparoscopic cholecystectomy. Radiol Case Rep 2021; 17:23-26. [PMID: 34760036 PMCID: PMC8567157 DOI: 10.1016/j.radcr.2021.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Isolated case reports and small series in radiologic and surgical literature relay the different modes of clinical presentation that arise secondary to spillage of gallstones during surgery. We report a case of a 70-year-old female who presented with a 2-week history of right-sided abdominal pain. CT (computerized tomography) imaging findings demonstrated multiple peripherally enhancing hypoattenuating lesions in the right subphrenic space abutting the hepatic dome, concerning for abscesses. The lesions were found to have a characteristic central hyperattenuating focus (Target Sign) consistent with gallstones, as identified on a pre-cholecystectomy CT, resulting in the early diagnosis and treatment of dropped gallstones from prior laparoscopic cholecystectomy approximately 1 year prior to presentation.
Collapse
Affiliation(s)
- Wendy Kendera
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Neel Shroff
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Esraa Al-Jabbari
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Maggie Barghash
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Arya Bagherpour
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| |
Collapse
|
3
|
Chen MZ, Arachchi A, Chouhan H. Rectal gallstone? ANZ J Surg 2020; 91:1296-1298. [PMID: 33022850 DOI: 10.1111/ans.16381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Zhiyun Chen
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Asiri Arachchi
- Department of Surgery, Monash Hospital, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Department of Surgery, Monash Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Sato S, Inoue A, Ota S, Furukawa A, Miyagawa Y, Wakamiya M, Hirose T, Furuichi K, Watanabe Y. Foreign-body granulomas and abscesses caused by dropped gallstones after cholecystectomy: Four cases diagnosed with multimodality imaging. Radiol Case Rep 2020; 15:1480-1484. [PMID: 32670445 PMCID: PMC7339004 DOI: 10.1016/j.radcr.2020.05.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Four cases (age range, 60-78 years, male:female = 1:3) who had undergone cholecystectomy presented with fever (n = 1), right abdominal pain with fever (n = 1), appetite loss with fever (n = 1), and absence of symptoms (n = 1). Computed tomography (CT) showed an irregular-shaped invasive mass or fluid collection in the right Morrison's pouch, right paracolic gutter, gallbladder fossa, subphrenic space, or abdominal wall. CT and ultrasound revealed gallstones in the granuloma in 3 cases and an abscess in one case. The inflammatory process induced by dropped gallstones may mimic peritoneal malignancies. Awareness of cholecystectomy and the detection of gallstones in the lesion are essential for the diagnosis of dropped gallstones.
Collapse
Affiliation(s)
- Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, 7-2-1, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Yoshihiro Miyagawa
- Department of Radiology, Nagahama City Hospital, 313, Oinui-cho, Nagahama-city, Shiga, 526-8580, Japan
| | - Makoto Wakamiya
- Department of Radiology, Nagahama City Hospital, 313, Oinui-cho, Nagahama-city, Shiga, 526-8580, Japan
| | - Tomohiro Hirose
- Department of Radiology, SaiseikaiNoe Hospital, 1-3-25, Furuichi, Joto-ku, Osaka-city, Osaka, 536-0001, Japan
| | - Kenji Furuichi
- Department of Radiology, SaiseikaiNoe Hospital, 1-3-25, Furuichi, Joto-ku, Osaka-city, Osaka, 536-0001, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| |
Collapse
|
5
|
Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt) 2019; 20:298-304. [DOI: 10.1089/sur.2018.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
6
|
Tiang KW, So HF, Hwang Y, Siddaiah-Subramanya M. Free Intraperitoneal Gallstone: An Unusual Case of Small Bowel Obstruction from Extrinsic Compression. Case Rep Surg 2018; 2018:1341572. [PMID: 29535884 PMCID: PMC5817355 DOI: 10.1155/2018/1341572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/14/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is preferred in the treatment of symptomatic cholecystolithiasis. Gallstone spillage is not uncommon, and there have been reports of associated complications. We report a case of a free intraperitoneal gallstone, left inadvertently during LC, which developed an inflammatory phlegmon with abscess containing gallstone, causing extraluminal compression on the distal ileum, resulting in small bowel obstruction. This complication in particular is almost unheard of. The patient underwent laparoscopic drainage of abscess and retrieval of gallstone, which relieved the obstruction. Clinicians, therefore, need to keep an open mind in the workup for bowel obstruction. During LC, gallstone spillage should be prevented and retrieved whenever possible to minimize early and late complications associated with it.
Collapse
Affiliation(s)
- Kor Woi Tiang
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- Griffith University, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Hang Fai So
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Yang Hwang
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Manjunath Siddaiah-Subramanya
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- Griffith University, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
7
|
Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article. Surg Laparosc Endosc Percutan Tech 2017; 26:183-92. [PMID: 27258908 DOI: 10.1097/sle.0000000000000274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC. METHODS We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications. RESULTS Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions. CONCLUSIONS Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
Collapse
|
8
|
Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features. Emerg Radiol 2014; 22:283-94. [PMID: 25537821 DOI: 10.1007/s10140-014-1291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/12/2014] [Indexed: 12/18/2022]
Abstract
Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.
Collapse
|
9
|
Out of Sight but Kept in Mind: Complications and Imitations of Dropped Gallstones. AJR Am J Roentgenol 2013; 200:1244-53. [DOI: 10.2214/ajr.12.9430] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
10
|
A case of persistent hiccup after laparoscopic cholecystectomy. Case Rep Surg 2013; 2013:206768. [PMID: 23691420 PMCID: PMC3638519 DOI: 10.1155/2013/206768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/17/2013] [Indexed: 11/17/2022] Open
Abstract
A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.
Collapse
|
11
|
Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report. Case Rep Surg 2012; 2012:573092. [PMID: 23227410 PMCID: PMC3513733 DOI: 10.1155/2012/573092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/08/2012] [Indexed: 11/18/2022] Open
Abstract
One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient's decision to refuse abscess's surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.
Collapse
|
12
|
Singh K, Wang ML, Ofori E, Widmann W, Alemi A, Nakaska M. Gallstone abscess as a result of dropped gallstones during laparoscopic cholecystectomy. Int J Surg Case Rep 2012; 3:611-3. [PMID: 23000379 DOI: 10.1016/j.ijscr.2012.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION With the advent of laparoscopic cholecystectomy we have seen a "disease of medical progress" (DOMP). Herein we report a complication that developed 7 years after laparoscopic cholecystectomy. PRESENTATION OF CASE A 42 year old woman presented with worsening right-sided pain and tenderness. Seven years prior she underwent a laparoscopic cholecystectomy. Computed tomography demonstrated a subhepatic retroperitoneal inflammatory mass. On open exploration a 4cm×6cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. DISCUSSION Laparoscopic cholecystectomy has become the "gold standard" for the treatment of symptomatic gallstones. Prior to laparoscopic cholecystectomy there was no body of literature about lost gallstones thus making this a DOMP. In contrast, it is reported that as many as 5.4-19% of laparoscopic cholecystectomies have stones spilled with variable rates of retrieval. Our case demonstrates an extreme example of a complication resulting seven years after a laparoscopic cholecystectomy with gallstones left behind. CONCLUSION Recognizing that gallstones will be lost during some cases of laparoscopic cholecystectomy, we must remain vigilant and make a full attempt to retrieve all stones to prevent such rare but not insignificant potential complications.
Collapse
Affiliation(s)
- Kuldeep Singh
- Department of Vascular Surgery, Staten Island University Hospital, 256 Mason Ave, Building B, Staten Island, NY 10305, USA
| | | | | | | | | | | |
Collapse
|
13
|
Wauben LSGL, Goossens RHM, Lange JF. Evaluation of operative notes concerning laparoscopic cholecystectomy: are standards being met? World J Surg 2010; 34:903-9. [PMID: 20112020 PMCID: PMC2848728 DOI: 10.1007/s00268-010-0422-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the most performed minimal invasive surgical procedure and has a relatively high complication rate. As complications are often revealed postoperatively, clear, accurate, and timely written operative notes are important in order to recall the procedure and start follow-up treatment as soon as possible. In addition, the surgeon's operative notes are important to assure surgical quality and communication with other healthcare providers. The aim of the present study was to assess compliance with the Dutch guidelines for writing operative notes for LC. METHODS Nine hospitals were asked to send 20 successive LC operative notes. All notes were compared to the Dutch guideline by two reviewers and double-checked by a third reviewer. Statistical analyses on the "not described" items were performed. RESULTS All hospitals participated. Most notes complied with the Dutch guideline (52-69%); 19-30% of items did not comply. Negative scores for all hospitals were found, mainly for lacking a description of the patient's posture (average 69%), bandage (94%), blood loss (98%), name of the scrub nurse (87%), postoperative conclusion (65%), and postoperative instructions (78%). Furthermore, notes from one community hospital and two teaching hospitals complied significantly less with the guidelines. CONCLUSIONS Operative notes do not always fully comply with the standards set forth in the guidelines published in the Netherlands. This could influence adjuvant treatment and future patient treatment, and it may make operative notes less suitable background for other purposes. Therefore operative note writing should be taught as part of surgical training, definitions should be provided, and procedure-specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.
Collapse
Affiliation(s)
- Linda S G L Wauben
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE, Delft, The Netherlands.
| | | | | |
Collapse
|
14
|
Cherif-Idrissi N, El Hajjam M, Acharki M, Chagnon S, Penna C, Lacombe P. [Dropped stone: a case report]. JOURNAL DE RADIOLOGIE 2010; 91:717-718. [PMID: 20808274 DOI: 10.1016/s0221-0363(10)70103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|