Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica

Right lumbar abscess containing a gallstone-an unexpected late complication of laparoscopic cholecystectomy

During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.

Peritoneo-cutaneous fistula from spilled gall bladder calculus following laparoscopic cholecystectomy

Inadvertent spillage of gall stones is a rare yet important cause of delayed postcholecystectomy complications. Varied presentations and difficulty in diagnosis are the hallmarks, making it crucial to have a high index of suspicion to detect and intervene appropriately. Peritoneo‐cutaneous fistulae from the retained stone can be completely excised in toto.

Gallstone-related abdominal cystic mass presenting 6 years after laparoscopic cholecystectomy: A case report

INTRODUCTION

Although gallbladder perforation and gallstones spillage are common complications during laparoscopic cholecystectomy (LC), clinically significant complications resulting from stones left in the peritoneum are extremely uncommon. We report a rare case of spilled gallstones complication with a late and uncharacteristic presentation.

PRESENTATION OF THE CASE

A 44-year-old Caucasian female presented with a complaint of a mass in the right upper quadrant associated with a cramping pain for the last 6 months. Her past surgical history included a laparoscopic cholecystectomy performed six years ago. Abdominal computed tomography demonstrated an intra-abdominal cystic mass. On open exploration, a cystic mass adhered to the abdominal wall was excised containing two gallstones. The patient tolerated the procedure well and had uneventful postoperative recovery.

DISCUSSION

Although unretrieved gallstones are considered harmless, serious complications can occur early or late. The most frequent complication is the formation of abscesses in different locations.

CONCLUSION

The diagnosis of gallstone abscess after years of LC is usually a diagnostic challenge. Obtaining a comprehensive past surgical history still plays an important role in the assessment of patients presenting with unusual findings.

The wanderlust of a gallstone: a case report of intrathoracic migration of a gallstone post complicated cholecystectomy mimicking lung cancer

Gallstones migrating into the right hemithorax post complicated cholecystectomy may be misdiagnosed for lung cancer, especially in the context of a distant history of cholecystectomy, poor recall of medical history and incomplete patient data. We present a case of a female patient with heavy smoking history who presented to our emergency department with haemoptysis and mild weight loss. Imaging workup showed an ¹⁸F-fludeoxyglucose positron emission tomography-positive heterogeneous nodule with central calcification in the right lower lobe, carrying lung cancer as a differential diagnosis. The resected specimen revealed an inflammatory pseudomass formed around a gallstone. This case illustrates the importance of knowing the spectrum of clinical and radiological presentation of a gallstone migrating into the right hemithorax, in order to prompt appropriate management and prevent misdiagnosis and mistreatment.

Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone

BACKGROUND

Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities.

METHODS

Case report and review of the literature.

CASE REPORT

A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved.

CONCLUSION

Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present.

Consequences of spilt gallstones during laparoscopic cholecystectomy

To document the incidence of spilt gallstones during laparoscopic cholecystectomy, the cause and consequences of such spillage. The study included 150 consecutive laparoscopic cholecystectomies performed between October 2007 and November 2008. Data was collected in a prospective manner in accordance to proforma. Follow up were performed at the end of 1 week, 1 month, 6 months and 1 year. The spillage of gall stones during surgery occurred in 19.04 % of the cases. Majority of the spillage occurred due to perforation of the gall bladder during dissection, followed by application of toothed grasper. Although all visible spilt stones were retrieved during surgery, complication rate of 0.66 % was observed. The incidence and complications secondary to the spillage of gall stones during standard laparoscopic cholecystectomy is low but avoidable. Various complications can occur, over a large period of time. Thus it is advisable to retrieve as many gallstones as possible short of converting to a laparotomy Dasari and Loan (JSLS 13(1):73-76, 2009), Daradkeh and Suwan (World J Surg 22:75-77, 1998).

Inflammatory pseudotumour secondary to spilled intra-abdominal gallstones

INTRODUCTION

Spillage of calculi in the abdomen is frequent during Laparoscopic Cholecystectomy (LC). Though uncommon, these stones may lead to early or late complications. We describe a rare case of spilled gallstone presenting four years after the index procedure, with a mass in the parietal wall mimicking a neoplastic lesion.

PRESENTATION OF CASE

A 50 year old male presented with a mass in the right upper quadrant for the past 2 years. His past surgical history included a LC done four years ago. Intraoperative procedural details of the surgery were not available. A Computed Tomography (CT) scan showed an extrahepatic mass in the subdiaphragmatic space extending onto the soft tissues of the parietal wall. He underwent laparoscopic piecemeal excision of this organized mass. His post operative period was uneventful and he was pain-free on follow up.

DISCUSSION

Gallbladder perforation can occur due to excessive traction during retraction or during dissection from the liver bed. It can also occur during extraction from the abdomen. Infected bile, pigment gallstones, male gender, advanced age, perihepatic location of spilled gallstones, more than 15 gallstones and an average size greater than 1.5cm have been identified as risk factors for complications. Definitive treatment is surgery with excision of the organized inflammatory mass and extraction of gallstones to avoid future recurrence.

CONCLUSION

Spilled gallstones can be a diagnostic challenge and can cause significant morbidity to the patient. Clear documentation of spillage and explanation to the patient is of utmost importance, as this will enable prompt recognition and treatment of any complications. Prevention of spillage is the best policy.