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Tokuda A, Maehira H, Iida H, Mori H, Nitta N, Maekawa T, Takebayashi K, Kaida S, Miyake T, Kuroda R, Yamamoto H, Tani M. Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report. Surg Case Rep 2022; 8:62. [PMID: 35389108 PMCID: PMC8991281 DOI: 10.1186/s40792-022-01419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC. CASE PRESENTATION We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up. CONCLUSIONS We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.
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Affiliation(s)
- Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Nobuhito Nitta
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Ryo Kuroda
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Haruka Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
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Sharma R, Meyer CA, Frazier AA, Martin Rother MD, Kusmirek JE, Kanne JP. Routes of Transdiaphragmatic Migration from the Abdomen to the Chest. Radiographics 2020; 40:1205-1218. [PMID: 32706612 DOI: 10.1148/rg.2020200026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diaphragm serves as an anatomic border between the abdominal and thoracic cavities. Pathologic conditions traversing the diaphragm are often incompletely described and may be overlooked, resulting in diagnostic delays. Several routes allow abdominal contents or pathologic processes to spread into the thorax, including along normal transphrenic structures, through congenital defects in the diaphragm, through inherent areas of weakness between muscle groups, or by pathways created by tissue destruction, trauma, or iatrogenic injuries. A thorough knowledge of the anatomy of the diaphragm can inform an accurate differential diagnosis. Often, intraperitoneal pathologic conditions crossing the diaphragm may be overlooked if axial imaging is the only approach to this complex region because of the horizontal orientation of much of the diaphragm. Multiplanar capabilities of volumetric CT and MRI provide insight into the pathways where pathologic conditions may traverse this border. Knowledge of these characteristic routes and use of multiplanar imaging are critical for depiction of specific transdiaphragmatic pathologic conditions.©RSNA, 2020.
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Affiliation(s)
- Ruchi Sharma
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Cristopher A Meyer
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Aletta A Frazier
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Maria D Martin Rother
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Joanna E Kusmirek
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Jeffrey P Kanne
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
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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.
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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.
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Video-assisted Thoracoscopic Surgery (VATS) drainage of salmonella enteritidis empyema and needle-localization for retrieval of a dropped gallstone. Surg Laparosc Endosc Percutan Tech 2010; 20:265-8. [PMID: 20729699 DOI: 10.1097/sle.0b013e3181e1392e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Spillage of gallstones into the peritoneal cavity (dropped gallstones) is more common in laparoscopic compared with open cholecystectomy. Subsequent infectious complications are often delayed, occurring in 0.1% to 2.9% of cases. We present the first reported case of Salmonella enterica subphrenic abscess and empyema complicating dropped gallstones, treated with video-assisted thoracoscopic surgery (VATS), and surgical retrieval. CASE REPORT A 67-year-old male with symptomatic cholelithiasis underwent an uncomplicated laparoscopic cholecystectomy. Four years later, he presented with a mass in his right flank, and an abdominal computed tomography (CT) revealed a right flank intramuscular abscess containing gallstones. The abscess was drained surgically with removal of gallstones. He was readmitted 15 months later with right upper quadrant pain, fever, and dyspnea. Chest and abdominal computer tomography (CT) showed a right pleural effusion and a right subphrenic abscess containing a dropped gallstone. The gallstone was localized with a needle using CT guidance. He subsequently underwent a right VATS for decortication. A separate flank incision was made at the site of the needle to drain the subphrenic abscess and retrieve the gallstone. Cultures from his empyema grew S enteritidis. The patient made an uneventful recovery. DISCUSSION During laparoscopic cholecystectomy, efforts should be made to retrieve dropped gallstones as they can cause abscess and empyema, which might necessitate furthermore surgical intervention. The use of VATS has been established as a safe and effective alternative to thoracotomy, including the treatment of empyema. Needle-localization resulted in a successful retrieval of the gallstone in our patient. Culture of the abscess is important, as unusual organisms such as Salmonella could be present. S. enteritidis has not been implicated as a cause of cholecystitis and is rarely associated with abdominal abscesses. We postulate that the organism reached the gallbladder through the bile or bloodstream after gastrointestinal colonization and that its persistence in the gallbladder may have been facilitated by gallstones.
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