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Danhel L, Fritz A, Havranek L, Kratzer T, Punkenhofer P, Punzengruber A, Rezaie D, Tatalovic S, Wurm M, Függer R, Biebl M, Kirchweger P. Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication-case report and review of the literature. Front Surg 2024; 11:1375502. [PMID: 38655209 PMCID: PMC11035747 DOI: 10.3389/fsurg.2024.1375502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC. Methods Case report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022. Case Report An 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation. Conclusion Intraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
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Affiliation(s)
- L. Danhel
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Fritz
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - L. Havranek
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - T. Kratzer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - P. Punkenhofer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Punzengruber
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - D. Rezaie
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - S. Tatalovic
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - M. Wurm
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - R. Függer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - M. Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - P. Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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Aitha S, Sasmal PK, Kumar P, Challawar R, Sinha M. Chronic abdominal wall sinus secondary to missed spilled gallstones in laparoscopic cholecystectomy: a harrowing experience. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:51-54. [PMID: 38494188 PMCID: PMC10961229 DOI: 10.7602/jmis.2024.27.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 03/19/2024]
Abstract
Gallbladder perforation with spillage of gallstones is not uncommon during laparoscopic cholecystectomy. Stone spillage can cause several complications. We report a case of recurrent discharging sinuses on the right back 4 years after laparoscopic cholecystectomy in a 44-year-old female patients. She suffered for 9 years to undergo empirical treatment for suspected tuberculosis, including repeated attempts at sinus tract excision done at different hospitals. We did a computed tomography sinogram, which revealed the tract extending from the right flank into a cavity in the right subpleural space. We proceeded with the sinus tract excision which extended between the tips of the 10th and 11th ribs, spreading to the right subpleural space where pus mixed with multiple gall stones were retrieved. Spilled stones may result in complications, making diagnosis difficult and seriously harming the patient physically, mentally, and economically. The need for accurate documentation and patient knowledge of missing gallstones cannot be understated.
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Affiliation(s)
- Saikrishna Aitha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prakash Kumar Sasmal
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pankaj Kumar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Rutuja Challawar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Medhavi Sinha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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Atri S, Hammami M, Sebai A, Hammami Y, Chaker Y, Kacem M. Dropped gallstone-related perihepatic abscess 20 years after open cholecystectomy. Int J Surg Case Rep 2023; 113:109047. [PMID: 37988985 PMCID: PMC10667767 DOI: 10.1016/j.ijscr.2023.109047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Gallstone spillage during cholecystectomy is a recognized complication that can lead to various postoperative complications. CASE PRESENTATION We present a rare case of a gallstone abscess that developed 20 years after an open cholecystectomy. An 80-year-old woman with a history of high blood pressure and previous gallbladder removal presented with severe abdominal pain. Imaging revealed a large abscess with a suspicious calcification, indicating a lost gallstone. Surgical intervention was performed, resulting in the removal of multiple gallstone fragments from the abscess cavity. CLINICAL DISCUSSION Gallbladder perforations and the spillage of gallstones are common complications during cholecystectomies, with laparoscopic procedures being more prone to stone spillage. Studies show a significant difference between open and laparoscopic cholecystectomies, with laparoscopy having a higher risk of spilled stones. Complications from spilled gallstones are rare but can vary in presentation and location. They may lead to long-term issues such as abscesses and even erosion into other organs. These complications can manifest years after surgery. Treatment involves evacuating the abscess and addressing the gallstone. Surgical intervention, like laparotomy or laparoscopy, is required for retrieval. Ensuring proper traction during surgery is crucial to prevent gallbladder perforation and stone spillage. Consideration of alternative, gentler instruments for traction may be beneficial. CONCLUSION Surgeons should be vigilant, proactive, and employ prophylactic measures to minimize complications related to gallstone spillage, ensuring the best possible patient outcomes.
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Affiliation(s)
- Souhaib Atri
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia
| | - Mahdi Hammami
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia.
| | - Amine Sebai
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia
| | - Yasmine Hammami
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia
| | - Youssef Chaker
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia
| | - Montassar Kacem
- General Surgery Department, Hopital la Rabta, Tunis, Tunisia
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Bofill AM, Mahmoud T, Takahashi EA, Chandrasekhara V. Endoscopic approach for management of dropped gallstones using percutaneous cholangioscopy. VideoGIE 2022; 8:23-26. [PMID: 36644251 PMCID: PMC9832278 DOI: 10.1016/j.vgie.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Video 1Endoscopic approach for management of dropped gallstones using percutaneous cholangioscopy.
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Affiliation(s)
- Aliana M Bofill
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Gavriilidis P, Catena F, de’Angelis G, de’Angelis N. Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review. World J Emerg Surg 2022; 17:57. [PMID: 36324150 PMCID: PMC9632095 DOI: 10.1186/s13017-022-00456-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. METHODS Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. RESULTS Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. CONCLUSIONS Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
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Affiliation(s)
- Paschalis Gavriilidis
- grid.412944.e0000 0004 0474 4488Department of Surgery, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ Cornwall UK
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gianluigi de’Angelis
- grid.10383.390000 0004 1758 0937Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Nicola de’Angelis
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, Clichy, France
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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.
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Mehmood S, Singh S, Igwe C, Obasi CO, Thomas RL. Gallstone extraction from a back abscess resulting from spilled gallstones during laparoscopic cholecystectomy: a case report. J Surg Case Rep 2021; 2021:rjab293. [PMID: 34316341 PMCID: PMC8302076 DOI: 10.1093/jscr/rjab293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Laparoscopic cholecystectomy is a routinely performed surgery nowadays. However, it is associated with certain complications. Gall bladder perforation during the procedure can result in spilled and lost gallstones. Lost gallstones most commonly cause intra-abdominal infection. However, very rarely, they can be associated with troublesome retroperitoneal abscess formation. We present a case where a lost gallstone caused a retroperitoneal abscess formation and was retrieved from a back abscess in the right paraspinal region.
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Affiliation(s)
- Saqib Mehmood
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Sohail Singh
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Chukwuemeka Igwe
- Internal Medicine, King Mill Hospital, Sutton-in-Ashfield NG17 4JL, UK
| | - Chekwas O Obasi
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Rhys L Thomas
- General Surgery, Croydon University Hospital, London, CR77YE, UK
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Quinn E, Capanegro J, Hartigan J. A case report: Delayed gallstone abscess formation 10 years post-cholecystectomy. Int J Surg Case Rep 2020; 77:903-905. [PMID: 33395921 PMCID: PMC7732970 DOI: 10.1016/j.ijscr.2020.11.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Successful removal of gallstones are important to prevent the formation of gallstone abscess and infection. An increase of reports of gallstone abscess formation shows the importance of awareness in the surgical community of the occurrence and proper treatment techniques. Proper treatment techniques include abscess drainage either surgically or non-invasive and if possible laparoscopic repair of gallstone abscess.
Introduction Retained gallstones post-cholecystectomy act as a nidus for abscess formation. It is unusual for intraabdominal abscesses to remain asymptomatic due to its propensity to cause inflammation and irritation to the peritoneum. Presentation of case A 73-year-old female presented with acute onset of right-sided abdominal pain and fever. Her past surgical history was significant for a cholecystectomy in 2010, hysterectomy, and partial nephrectomy. She was diagnosed with an intraabdominal abscess secondary to a retained gallstone post-cholecystectomy. She underwent laparoscopic surgery to drain and remove the abscess. The patient's abdominal pain improved, remains afebrile, and is passing stool regularly. Discussion Gallbladder perforation is common and is dependent on the integrity of the gallbladder and surrounding structures. It is unusual for an intra-abdominal abscess to develop so late following gallstone spillage. This example brings to light the potential long-term sequelae of gallbladder perforation and future complications. Conclusion This case highlights the importance of irrigation of the peritoneal cavity and retrieval any spilled gallstones during surgery in the event of gallbladder perforation.
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Affiliation(s)
- Erina Quinn
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA.
| | - James Capanegro
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
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9
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Tchercansky AN, Fernandez Alberti J, Panzardi N, Auvieux R, Buero A. Thoracic empyema after gallstone spillage in times of Covid. Int J Surg Case Rep 2020; 76:221-226. [PMID: 33042769 PMCID: PMC7531285 DOI: 10.1016/j.ijscr.2020.09.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 11/19/2022] Open
Abstract
Thoracic complications after spilled gallstones are rare. Thoracic consequences should be considered in every patient with thoracic symptoms and history of cholecystectomy. Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients. Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment.
Introduction Laparoscopic cholecystectomy has become the gold standard for gallbladder disease. Although gallbladder perforation and spilled gallstones during surgery are common complications, thoracic consequences are rare. Presentation of case We describe a case of a pleural empyema developed in an immunosuppressed patient five months after laparoscopic cholecystectomy, as a result of spilled gallstones. Decortication via video assisted thoracoscopy resulted in retrieval of stone remnants, biliary sludge and diagnosis of a diaphragmatic defect. Discussion Iatrogenic perforation of the gallbladder is the most common complication after laparoscopic cholecystectomy. Despite this, thoracic consequences derived from spilled gallstones are rare, but they represent significant morbidity. Conclusion Thoracic complications after spilled gallstones are rare. Documentation of iatrogenic perforation of the gallbladder and a high index of suspicious are fundamental to speed diagnosis and treatment.
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Affiliation(s)
| | | | - Nicolas Panzardi
- General Surgery Department, British Hospital of Buenos Aires, Argentina
| | - Rodolfo Auvieux
- Thoracic Surgery Department, British Hospital of Buenos Aires, Argentina
| | - Agustin Buero
- Thoracic Surgery Department, British Hospital of Buenos Aires, Argentina
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10
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Infected Renal Cyst as a Complication of Dropped Gallstones during Laparoscopic Cholecystectomy. Case Rep Gastrointest Med 2018; 2018:2478245. [PMID: 30405920 PMCID: PMC6186367 DOI: 10.1155/2018/2478245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Dropped gallstones are a relatively common complication, occurring in 3% to 32% of laparoscopic cholecystectomies performed, depending on various intraoperative risk factors. However, complications arising from dropped gallstones are relatively rare, occurring in fewer than 1% of such patients, and can include abscesses and inflammatory masses confined to the subhepatic space, presenting days to years later. We report a patient who developed an infected renal cyst as a result of dropped gallstones, which created a fistula from the duodenum to a previously simple right renal cyst, which was initially identified on an abdominal CT scan. Dropped gallstones can result in substantial morbidity in a minority of patients following cholecystectomy performed for cholecystitis, and a high clinical as well as radiological index of suspicion may be required for accurate early recognition and treatment.
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11
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Akhtar A, Bukhari MM, Tariq U, Sheikh AB, Siddiqui FS, Sohail MS, Khan A. Spilled Gallstones Silent for a Decade: A Case Report and Review of Literature. Cureus 2018; 10:e2921. [PMID: 30202664 PMCID: PMC6128371 DOI: 10.7759/cureus.2921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Laparoscopic cholecystectomy is associated with complications such as gallbladder perforation and spillage of gallstones. While these shortcomings are common, the occurrence of the resultant nuisances, such as intra-abdominal abscesses, is infrequent. We present the case of an individual who developed an intra-abdominal abscess following a spillage of gallstones, which occurred after a laparoscopic cholecystectomy that was performed more than a decade ago. Herein, we also discuss the findings of a literature review that highlights the clinical presentations of an intra-abdominal abscess formed due to gallstone spillage after a decade of the laparoscopic intervention. We also discuss the underlying pathophysiology leading to abscess formation, the imaging modalities used to visualize the abscess, as well as the therapeutic strategy used to treat this rare clinical entity.
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Affiliation(s)
- Aisha Akhtar
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Marvi M Bukhari
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | | | | | | | - Amina Khan
- Internal Medicine, Shifa Tameer E Millat University/shifa International Hospital, Islamabad, PAK
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12
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Spilled gallstones simulating peritoneal carcinomatosis: A case report and literature review. Int J Surg Case Rep 2018; 48:113-121. [PMID: 29885915 PMCID: PMC6041376 DOI: 10.1016/j.ijscr.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) has become the "gold standard" for the treatment of symptomatic gallstones. However, this surgical technique increases the risk of bile duct injury and lost gallstones. Since over 90% of split gallstones never become symptomatic, they often present as incidental findings on CT-scans. Careful removal of as many stones as possible, intense irrigation and suction are recommended. It has been reported that 8.5% of lost gallstones will lead to a complication, most common are abscesses. PRESENTATION CASE We report a case of spilled gallstones simulating peritoneal metastases on radiological investigations. Diagnosis was very difficult, not even an US-guided biopsy of the lesion was decisive. Only a diagnostic laparoscopy confirms the diagnosis. DISCUSSION The reaction associated with lost gallstones can mimic other causes, such as soft tissue sarcoma, malignant lymphoma or, as in our case peritoneal carcinomatosis. CONCLUSION Spilled gallstones are associated with uncommon, but significant complications, and even the diagnosis of such a condition can cause serious difficulties. Serious effort must be made to prevent gallbladder perforation, and accidental stone spillage should be promptly recognized and properly managed.
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Affiliation(s)
- G T Capolupo
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - G Mascianà
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy.
| | - F Carannante
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - M Caricato
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
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13
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Canna A, Adaba F, Sezen E, Bissett A, Finch GJ, Ihedioha U. Para-spinal abscess following gallstones spillage during laparoscopic cholecystectomy: an unusual presentation. J Surg Case Rep 2017; 2017:rjx052. [PMID: 28458858 PMCID: PMC5400479 DOI: 10.1093/jscr/rjx052] [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] [Received: 01/13/2017] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
Gallbladder perforation with subsequent gallstone spillage can occur with higher frequency in laparoscopic cholecystectomy than in traditional open approach. Gallstone abscess formation from stone spillage post-cholecystectomy is extremely rare. We present a case of para-spinal abscess formation 5 years after spilled gallstones following laparoscopic cholecystectomy.
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Affiliation(s)
- A. Canna
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - F. Adaba
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - E. Sezen
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - A. Bissett
- Department of Radiology, Northampton General Hospital, Northampton, UK
| | - GJ. Finch
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - U. Ihedioha
- Department of General Surgery, Northampton General Hospital, Northampton, UK
- Corresponding address. Department of General Surgery, Northampton General Hospital, Northampton NN1 5BD, UK.
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14
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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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15
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Lentz J, Tobar MA, Canders CP. Perihepatic, Pulmonary, and Renal Abscesses Due to Spilled Gallstones. J Emerg Med 2017; 52:e183-e185. [PMID: 28174034 DOI: 10.1016/j.jemermed.2016.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spilled gallstones are common during laparoscopic cholecystectomy; however, they rarely lead to postoperative complications. Perihepatic abscesses develop in < 0.1% of patients with spilled gallstones and are typically contained within the peritoneal cavity. CASE REPORT We present a 57-year-old man with history of cholecystectomy 2 years prior who presented with cough and flank pain and was discovered to have a perihepatic abscess invading his lung and kidney secondary to a spilled gallstone. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: Although most perihepatic abscesses can be treated with percutaneous drainage and antibiotics, abscesses secondary to spilled gallstones usually require open or laparoscopic surgery to drain the abscess and retrieve the gallstone. Prompt identification of spilled gallstones in patients with intra-abdominal and intrathoracic abscesses can thereby guide disposition and decrease morbidity and mortality.
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Affiliation(s)
- Jacob Lentz
- Department of Emergency Medicine, UCLA Medical Center, Los Angeles, California
| | - Maria A Tobar
- The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caleb P Canders
- Department of Emergency Medicine, UCLA Medical Center, Los Angeles, California
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Guerra F, Balestra F, Sacchetti R, Pulighe F, De Nisco C. An unsuspected cause of abdominal pain and fever: lost gallstone-related perisplenic abscess. J Dig Dis 2016; 17:554-556. [PMID: 27254834 DOI: 10.1111/1751-2980.12366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Fabio Pulighe
- Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Carlo De Nisco
- Department of Surgery, San Francesco Hospital, Nuoro, Italy
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Necrotizing Soft Tissue Infection Caused by Spilled Gallstones. ACG Case Rep J 2016; 3:212-3. [PMID: 27144208 PMCID: PMC4843160 DOI: 10.14309/crj.2016.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/03/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 57-year-old woman who presented with a necrotizing soft tissue infection of the right anterior abdominal wall, 1 year after open cholecystectomy for gallbladder perforation. Surgical exploration revealed pigmented gallstones along with pus in the abdominal wall and gallbladder fossa. Intraoperative spillage of gallstones is common during both open and laparoscopic cholecystectomy, but, in rare cases, can lead to serious complications including necrotizing infection of the abdominal wall.
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18
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Dropped Gallstones Causing a Perihepatic Abscess and Empyema. Case Rep Surg 2015; 2015:629704. [PMID: 26137343 PMCID: PMC4475532 DOI: 10.1155/2015/629704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/25/2015] [Indexed: 11/18/2022] Open
Abstract
Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy is a well-known occurrence; however, the consequences of spillage of gallstones in the peritoneum and particularly intrathoracic complications are less defined. We describe the delayed development of a perihepatic abscess and empyema in a patient five years following laparoscopic cholecystectomy secondary to dropped gallstones. A 53-year-old man with medical history significant for a laparoscopic cholecystectomy five years prior to acute cholecystitis presented with purulent cough, hemoptysis, night sweats, and right-upper quadrant (RUQ) pain. Computed tomography (CT) scan revealed 5.4 cm right-sided subpulmonic and 5.9 cm perihepatic fluid collections with an 8 mm focal radiopaque density within the perihepatic fluid collection. Open intra-abdominal exploration resulted in retrieval of a 1 cm intraperitoneal gallstone. Laparoscopic cholecystectomy is a common surgical operation during which gallstone spillage can occur, causing both intra-abdominal and intrathoracic complications, presenting even years after surgery. This necessitates an attempt to retrieve all free intra-abdominal gallstones during the initial operation.
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Stevens JL, Laliotis A, Gould SWT. Hepatocolonic fistula: a rare consequence of retained gallstones after laparoscopic cholecystectomy. Ann R Coll Surg Engl 2013; 95:e139-41. [PMID: 24165331 DOI: 10.1308/003588413x13629960048550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Spillage of gallstones during laparoscopic cholecystectomy occurs in up to 30% of cases but complications due to stone retention are less frequent. We report the first case of a hepatocolonic fistula as a consequence of a retained gallstone.
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Affiliation(s)
- J L Stevens
- Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
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20
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Stevens JL, Laliotis A, Gould SWT. Hepatocolonic fistula: a rare consequence of retained gallstones after laparoscopic cholecystectomy. Ann R Coll Surg Engl 2013; 95:15-9. [DOI: 10.1308/rcsann.2013.95.8.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spillage of gallstones during laparoscopic cholecystectomy occurs in up to 30% of cases but complications due to stone retention are less frequent. We report the first case of a hepatocolonic fistula as a consequence of a retained gallstone.
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Affiliation(s)
- JL Stevens
- North West London Hospitals NHS Trust, UK
| | - A Laliotis
- North West London Hospitals NHS Trust, UK
| | - SWT Gould
- North West London Hospitals NHS Trust, UK
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21
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Ladic A, Petrovic I, Augustin G, Puretic H, Skegro M, Gojevic A, Nikolic I. Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone. Surg Infect (Larchmt) 2013; 14:408-11. [PMID: 23859691 DOI: 10.1089/sur.2012.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Agata Ladic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
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22
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Abstract
An unusual collection of fluid in the perihepatic space needs to be investigated for abscess in patients with a remote history of cholecystectomy. Background: A common intraoperative complication during laparoscopic cholecystectomy is gallbladder perforation with spillage of gallstones. The undesirable consequence of spilled gallstones is the formation of abscesses months or years after an operation. Case Description: Our clinical report describes an intraabdominal abscess formation in an 82-year-old man that developed 8 years after a laparoscopic cholecystectomy. A computed tomography scan of the abdomen showed an elongated fluid collection in the right abdominal compartment musculature at the level of the internal oblique muscle. Abdominal ultrasonography confirmed a large fluid collection, with 2 echogenic masses in the dependent portion. Incision and drainage of the abscess were performed, and 2 gallstones were found. Conclusion: Any unusual collection of fluid in the perihepatic space and abdominal wall in the area of the surgical incision in a patient with a remote history of cholecystectomy should be evaluated for abscess related to retained gallstone. Early abscess formation is usually diagnosed and treated by the surgeon. However, the late manifestation might be a clinical problem seen in the primary care physician's office. Therefore, the primary care physician should incorporate diagnosis of gallstone-related abscess in patients with abdominal abscess formation of unknown etiology.
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23
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Christensen AM, Christensen MM. Abdominal wall abscess containing gallstones as a late complication to laparoscopic cholecystectomy performed 17 years earlier. J Surg Case Rep 2013; 2013:rjs038. [PMID: 24963934 PMCID: PMC3578667 DOI: 10.1093/jscr/rjs038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. The laparoscopic procedure is superior to the open approach in many aspects. Intraperitoneal spillage of bile and gallstones is one of the most common accidental occurrences of LC. We present a case of a 53-year-old woman who developed two abscesses—one intra-abdominally and one in the abdominal wall—17 years after an LC. Three gallstones were found during surgical excision of the abdominal wall abscess. Surgeons should strive to avoid perforation of the gall bladder during LC. If spillage is inevitable attempts should be made to laparoscopically extract as many stones as possible. Documentation of (suspected) spillage is paramount when evaluating the possibility of postoperative complications, even many years later.
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24
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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.
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25
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Rammohan A, Srinivasan UP, Jeswanth S, Ravichandran P. Inflammatory pseudotumour secondary to spilled intra-abdominal gallstones. Int J Surg Case Rep 2012; 3:305-7. [PMID: 22543231 DOI: 10.1016/j.ijscr.2012.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/17/2012] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Ashwin Rammohan
- Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India
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26
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McVeigh G, McComiskey M, McCluggage WG. Peritoneal bile granulomas identified at Cesarean section and mimicking disseminated malignancy. Int J Surg Pathol 2011; 20:89-91. [PMID: 21632640 DOI: 10.1177/1066896911409930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 37-year-old woman was found to have multiple peritoneal nodules, including on the uterine serosa, at Cesarean section. Histology showed yellow crystalline material surrounded by histiocytes and occasional multinucleate giant cells. Further enquiry revealed that the patient underwent a cholecystectomy for a perforated gallbladder 3 years earlier. Pathologists should be aware of this uncommon complication of bile leakage, which has the potential to clinically mimic disseminated malignancy. This may become increasingly common in the future since bile leakage is more likely to occur with laparoscopic than open cholecystectomy.
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Affiliation(s)
- Gerard McVeigh
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
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27
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Justinger C, Sperling J, Katoh M, Kollmar O, Schilling MK, Schuld J. Retroperitoneal abscess with consecutive acute renal failure caused by a lost gallstone 2 years after laparoscopic cholecystectomy. Langenbecks Arch Surg 2010; 395:285-7. [PMID: 20082093 DOI: 10.1007/s00423-009-0587-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 12/14/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Christoph Justinger
- Department of General, Visceral, Vascular and Pediatric Surgery, University of the Saarland, D-66421 Homburg, Saarland, Germany
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28
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Park JI, Hur CY, Kim JS, Kim KH, Kim KH, Park OH, Choi CS, Choi YK. Percutaneous Removal of Spilled Gallstones after Laparoscopic Cholecystectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.1.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong-Ik Park
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chan-Young Hur
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin-Soo Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwang-Hee Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Oh-Hwan Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Soo Choi
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Kil Choi
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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29
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Awwad A, Mulholland K, Clements B. Abdominal abscess due to retained gallstones 5 years after laparoscopic cholecystectomy. BMJ Case Rep 2010; 2010:bcr07.2009.2126. [PMID: 22242063 DOI: 10.1136/bcr.07.2009.2126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 76-year-old female patient with diabetes presented with pyrexia and a recurrent painful right sided loin swelling. One year previously she had undergone radiological drainage of a large right sided loin abscess. At index presentation she was investigated both radiologically and endoscopically and a source for the abscess was not found. On this presentation, a computed tomography scan confirmed a large retroperitoneal abscess pointing through the lateral abdominal wall musculature. Surgical drainage was undertaken whereby the abscess was drained and several large gallstones extruded through the incision. The patient subsequently recuperated and the wound has healed successfully by second intention. Five years previously the patient had undergone an "uncomplicated" laparoscopic cholecystectomy. This case highlights the catastrophic late effects of dropped gallstones during laparoscopic cholecystectomy.
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Affiliation(s)
- Amir Awwad
- Royal Victoria Hospital, General Surgery, Belfast, Co Fermanagh BT12, UK
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30
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Murphy JA, Vimalachandran CD, Howes N, Ghaneh P. Anterior abdominal wall abscess secondary to subcutaneous gallstones. Case Rep Gastroenterol 2008; 2:219-23. [PMID: 21490892 PMCID: PMC3075147 DOI: 10.1159/000137375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Abdominal wall abscess secondary to spontaneous cholecystocutaneous gallstone fistulation is an uncommon presentation of a rare pathological process. Having been described relatively frequently in the 19th century, it is now much less common in the late 20th and early 21st century, probably due to earlier recognition of symptoms, better imaging and surgical treatment of biliary tract disease. Here we describe a report of a case with an unusual clinical presentation of the already rare pathological disease process of spontaneous cholecystocutaneous fistula.
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Affiliation(s)
- John A Murphy
- Division of Surgery and Oncology, Royal Liverpool University Hospital, Liverpool, UK
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31
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Castellón-Pavón CJ, Morales-Artero S, Martínez-Pozuelo A, Valderrábano-González S. Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica. Cir Esp 2008; 84:3-9. [DOI: 10.1016/s0009-739x(08)70596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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[Perihepatic abscess due to a gallstone left in the abdominal cavity]. Cir Esp 2008; 83:216-7. [PMID: 18358187 DOI: 10.1016/s0009-739x(08)70554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007; 193:73-8. [PMID: 17188092 DOI: 10.1016/j.amjsurg.2006.05.015] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones. DATA SOURCES A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones. CONCLUSION Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.
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Affiliation(s)
- Jörg Zehetner
- Department of Surgery, Ludwig Boltzmann Institute for Operative Laparoscopy, AKH Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
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Villar del Moral JM, Villegas-Herrera MT, Medina-Benítez A, Ramia-Angel JM, Garrote-Lara D, Ferrón-Orihuela JA. Retroperitoneoscopy to Extract Dropped Gallstones After Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2006; 16:290-3. [PMID: 16796443 DOI: 10.1089/lap.2006.16.290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.
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35
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Suyapto D, Tian-Hui Tan J. Complications of Retained Intraperitoneal Gallstones From Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2006; 16:167-8. [PMID: 16804461 DOI: 10.1097/00129689-200606000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Laparoscopic cholecystectomy is now the gold standard procedure for the treatment of symptomatic gall bladder stones. Spillage of gall bladder stones into the peritoneal cavity may occur due to inadvertent iatrogenic gall bladder perforation during dissection of the gall bladder. We report a case of a 66 year old woman who had to return to theatre three times over two years to deal with complications from retained intra-peritoneal gallstones that were spilt at her initial laparoscopic cholecystecomy.
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Affiliation(s)
- Dion Suyapto
- Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia, Australia
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36
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Grubb K, Gagandeep S, Chatzoulis G, Basa N, Palmer S, Correa A, Jabbour N. Surgical clips: a nidus for foreign body reaction after hepatic resection. Surg Laparosc Endosc Percutan Tech 2005; 15:363-5. [PMID: 16340571 DOI: 10.1097/01.sle.0000191586.38744.bf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case report describes a patient who underwent segment IV hepatic resection and 7 months later developed an abdominal wall abscess. This was a foreign body reaction to the surgical clips. The patient required an exploratory laparotomy with debridement and excision of the inflammatory mass in the anterior abdominal wall. Although occurrence is rare, foreign body reactions to surgical clips have been reported, especially as a complication of laparoscopic surgery.
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Affiliation(s)
- Kendra Grubb
- Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, University of Southern California, University Hospital, Los Angeles, CA 90033, USA
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Wölnerhanssen BK, Ackermann C, Guenin MO, Kern B, Tondelli P, von Flüe M, Peterli R. [Twelve years of laparoscopic cholecystectomy]. Chirurg 2005; 76:263-9. [PMID: 15502891 DOI: 10.1007/s00104-004-0928-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED We studied developments in indication, operation time, conversion rate, morbidity, and mortality from the beginning of laparoscopic cholecystectomy. Between 1990 and 2002 we prospectively evaluated 4498 patients undergoing cholecystectomy (CE), of whom 79% were treated laparoscopically (lap). In 6.6%, the procedure had to be converted from laparoscopic to open cholecystectomy (con), and 14% were performed open from the beginning (open). During the above time period, the rate of open CE decreased steadily (49% in 1990 to 7.2% in 2002). The average operation time of lap CE remained constant with an average of 74 min (range 20-330). The conversion rate decreased in spite of broader indication for lap CE in even more complicated gallstone diseases, from an initial 9.4% to 2.5%. Among intraoperative complications in lap and con, bile duct lesions remained constant with 5/3856 (0.1%), bleeding which led to conversion decreased from 1.9% to 0.3%, and the rate of gall bladder perforation increased from 12% to 20.5%. Thirty-day morbidity was 2% in lap CE, 5% in con, and 11.5% in open. The mortality was 0% in lap, 0.7% in con, and 1% in open. CONCLUSION Since the introduction of laparoscopic cholecystectomy the indication for this minimal-invasive operation steadily increased, the conversion-rate decreased and the complication-rate could be held low. Even with fast laparoscopic experience 7% of all cholecystectomies are technically difficult and remain to be carried out primarily in an open technique. The laparoscopic cholecystectomy has become the gold standard in the therapy of gallstone disease.
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Abstract
Laparoscopic surgery is the most significant advancement in the field of surgery over the past 15 years. This minimal access approach has been widely embraced and adopted to many common operations. Demonstrated benefits include decreased post-operative pain, shorter lengths of in-patient hospitalization, increased patient acceptance, and a more rapid return to gainful employment. With its ever-growing popularity, it has become fertile ground for civil litigation, ranking along with birth injuries and failure to diagnose cancer. A brief synopsis of the history of its evolution is presented along with general and specific comments concerning potential errors as they relate to specific common operations which are commonly done utilizing this technique.
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Affiliation(s)
- Earl Gaar
- Department of Surgery, University of Louisville School of Medicine and Louisville Veterans Administration Medical Center, Louisville, Kentucky, USA.
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39
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Aytekin FO, Tekin K, Kabay B, Erdem E, Erbis H, Ozden A. Role of a hyaluronic-acid derivative in preventing surgical adhesions and abscesses related to dropped bile and gallstones in an experimental model. Am J Surg 2004; 188:288-93. [PMID: 15450836 DOI: 10.1016/j.amjsurg.2004.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Revised: 04/30/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite its advantages, iatrogenic gallbladder perforation with resultant spillage of bile and gallstones is not uncommon during laparoscopic cholecystectomy. Although this is not generally considered a significant problem, spilled gallstones may cause problems even years after the operation. Hyaluronic acid has been introduced into clinical practice and successfully used to decrease postoperative adhesions after abdominopelvic surgery. In this study, we investigated the effectiveness of a hyaluronic-acid derivative in preventing complications related to spilled gallstones and bile leakage in an experimental study. METHODS In 60 Wistar-Albino rats, an upper-midline abdominal incision was made, and the rats were divided into 5 groups (n = 12 in each group) as follows: group I = laparotomy alone; group II = laparotomy and intraperitoneal instillation of sterile bile plus gallstones; group III = laparotomy and instillation of infected bile and gallstones; group IV = laparotomy and instillation of sterile bile and gallstones plus hyaluronic acid; and group V = laparotomy and instillation of infected bile and gallstones plus HA. A second-look laparotomy was performed on postoperative day 10 to assess intraperitoneal adhesions and abscesses. Intraperitoneal adhesions were scored, and breaking strengths of gallstones were measured. RESULTS Adhesion scores were significantly higher in groups II and III compared with groups I, IV, and V (P < 0.05). There was a statistically significant decrease in breaking strengths and adhesion scores in groups IV and V compared with groups II and III (P < 0.001). CONCLUSIONS Whether infected or not, spilled gallstones and bile caused postoperative adhesions in this experimental model. An HA derivative significantly prevented postoperative adhesions and decreased breaking strengths. Further clinical studies are needed to validate these findings.
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Affiliation(s)
- Faruk O Aytekin
- Pamukkale University Medical School, Department of General Surgey, Denizli, Turkey.
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Gore RM, Berlin JW, Yaghmai V, Mehta U, Newmark GM, Ghahremani GG. CT diagnosis of postoperative abdominal complications. Semin Ultrasound CT MR 2004; 25:207-21. [PMID: 15272546 DOI: 10.1053/j.sult.2004.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard M Gore
- Department of Radiology, Evanston Northwestern Healthcare, Northwestern University, Evanston, IL 60201, USA.
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Shamiyeh A, Wayand W. Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 2004; 389:164-71. [PMID: 15133671 DOI: 10.1007/s00423-004-0470-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 02/03/2004] [Indexed: 02/07/2023]
Abstract
UNLABELLED Laparoscopic cholecystectomy gained wide acceptance as treatment of choice for gallstone disease and cholecystitis. With this new technique, not only did the new era of minimal invasive surgery begin, but also the spectrum of complications changed. Laparoscopy-related complications such as access injuries and procedure-related problems are discussed in our article. Typical mishaps are reviewed according to the literature. Set-up of the pneumoperitoneum (morbidity up to 0.2%); bleeding-from trocar sites and vascular injury (mortality up to 0.2%); biliary leaks and bile duct injuries are the main topics in this article (still on a level of 0.2%-0.8%). Aetiology, diagnosis and treatment are discussed, and an overview of the most cited classifications of bile duct injuries is summarised graphically. Finally, bowel injuries as a specific complication in laparoscopy are discussed (incidence up to 0.87%). CONCLUSION Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe laparosopic cholecystectomy.
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Affiliation(s)
- A Shamiyeh
- Ludwig Boltzmann Institute for Operative Laparoscopy and 2nd Surgical Department, Academic Teaching Hospital of Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
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