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Orschel C, Gammel L, Bray SA, Burns B. Incarcerated Inguinal Hernia Containing a Gallstone Found Decades After a Laparoscopic Cholecystectomy. Cureus 2023; 15:e44518. [PMID: 37790052 PMCID: PMC10544610 DOI: 10.7759/cureus.44518] [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: 03/10/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Iatrogenic gallbladder perforation and subsequent gallstone spillage is a common problem in laparoscopic cholecystectomy. While most commonly asymptomatic, complications due to spilled gallstones have been reported. In this case study, we report the case of a 96-year-old female with a history of laparoscopic cholecystectomy at an unknown time who presented with an incarcerated inguinal hernia and small bowel obstruction. Imaging revealed an extraluminal radiopaque foreign body located near the hernia sac. At the time of the repair, she was found to have a single gallstone located within the hernia sac, confirmed by pathology. The hernia was repaired using Lichtenstein, and her bowel obstruction was resolved postoperatively. Although gallstone spillage from iatrogenic gallbladder perforation during laparoscopic cholecystectomy is a relatively common problem, it is rarely symptomatic and may be associated with infection, abscess, and fistula formation. A rarer complication includes the formation of hernias containing gallstones, documented in fewer than 10 cases in the literature. This case demonstrates a rare consequence of leaving behind spilled gallstones following gallbladder perforation during laparoscopic cholecystectomy. It emphasizes the importance of preventing iatrogenic gallbladder perforation and retrieving any spilled gallstones during the procedure to minimize associated complications.
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Affiliation(s)
- Catlin Orschel
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Lauren Gammel
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Sheree A Bray
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Bracken Burns
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
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Bolat H, Teke Z. Spilled gallstones found incidentally in a direct inguinal hernia sac: Report of a case. Int J Surg Case Rep 2019; 66:218-220. [PMID: 31874379 PMCID: PMC6931096 DOI: 10.1016/j.ijscr.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/11/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. Iatrogenic gallbladder perforation and spillage of gallstones during LC is a frequent occurrence. There are many different clinical presentations of complications resulting from dropped gallstones. We herein present a case of scattered gallstones after LC encountered incidentally during a direct inguinal hernia repair. PRESENTATION OF CASE A 62-year-old male presented with a 4-year history of swelling of both right and left groins. He had undergone LC for acute calculous cholecystitis at another hospital 5 months earlier. Physical examination revealed reducible both right and left direct inguinal hernias. Surgical exploration of the right side revealed foreign bodies at the fundus of the sac attached to the inner wall, with a fibrotic reaction around it. On closer inspection these foreign bodies were macroscopically consistent with gallstones. The gallstones were removed, and bilateral herniotomies and Lichtenstein's prolene mesh repair were performed. Pathologic evaluation confirmed 10 foreign bodies of 5-mm in size to be cholesterol gallstones. DISCUSSION Gallstones have been very rarely reported previously within a hernia sac after LC. Most of the spilled gallstones are clinically silent and rarely become symptomatic. Complications may occur from the immediately postoperative period to a long time interval of 20 years. Treatment of complications is based on its type and location. CONCLUSION This case presents a very rare entity resulting from leaving spilled gallstones behind. We recommend that every effort should be made to retrieve any scattered stones during LC in order to avoid complications.
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Affiliation(s)
- Haci Bolat
- Nigde Omer Halisdemir University, Faculty of Medicine, Department of General Surgery, Nigde, Turkey.
| | - Zafer Teke
- Cukurova University, Faculty of Medicine, Department of Surgical Oncology, Adana, Turkey
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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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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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Attitudes and Practices of Surgeons towards Spilled Gallstones during Laparoscopic Cholecystectomy: An Observational Study. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:381514. [PMID: 27355068 PMCID: PMC4897463 DOI: 10.1155/2014/381514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/14/2014] [Indexed: 11/24/2022]
Abstract
The sequelae of spilled gallstones after Laparoscopic cholecystectomy (LC) and the occurring complications may go unnoticed for a long time and can be a diagnostic challenge. The aim of this survey was to study the knowledge, attitude, and practices of surgeons regarding spilled gallstones during LC. An observational, cross-sectional survey, using a questionnaire based on 11 self-answered close-ended questions, was conducted among general surgeons. Of the 138 respondents only 29.7% had observed a complication related to gallstone spillage during LC. There was varied opinion of surgeons regarding management of spilled gallstones, documenting the same in operative notes and consent. It was observed that there is lack of knowledge regarding the complications related to gallstone spillage during LC. There is need to educate surgeons regarding safe practices during LC to avoid gallstone spillage, early diagnosis, and management of complications. There is need to standardize practice to retrieve lost gallstones to reduce complication and legal consequences.
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Abstract
INTRODUCTION Complications caused by lost gallstones within the abdominal cavity are well known. Abscesses, perforation of the gastro-intestinal tract were all described in the literature, but gallstones were found in hernial sac, or even in sputum after it penetrated through the diaphragm into the respiratory tract. These complications can develop between several weeks to several years postoperatively. Most complications can be treated surgically only. MATERIALS AND METHODS Fifty gallstones and bile samples were collected from 50 patients who underwent cholecystectomy (36 female / 14 male, avarge age: 60.8 ± 6.8 years). All samples were sent for microbiological examination. RESULTS bacterial colonization of the gallstone and the bile were found in 16 cases. Four of them showed acute inflammation in the gallbladder while pathological signs of chronic inflammation in the gallbladder wall were detected in eight cases. Empyema was found in four cases. Bacteria from enteral origin (Esherichia coli, Enterococcus faecalis, Enterobacter cloacae) was detected in 13 cases, while non-enteral (Klebsiella penumoniae, Streptococcus alfa-haemoliticus) colony were detected in three cases. Positive bacterial cultures were identified in twelve female and fourmale patients. CONCLUSIONS Different types of bacteria can be found in the gallstones, which may cause various complications.
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Affiliation(s)
- Bernadett Lévay
- Országos Onkológiai Intézet Fej-Nyaki Daganatok Multidiszciplináris Központ 1124 Budapest Ráth György u. 7-9
| | - Györgyi Szabó
- Semmelweis Egyetem Kísérletes Sebészeti és Műtéttani Intézet Budapest
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Abstract
In recent years, laparoscopic cholecystectomy (LC) has become the standard surgical practice for the treatment of cholecystolithiasis. As a recognized technical difficulty, it may be associated with the mechanical injury of the gallbladder and/or spilling some of the gallstones into the abdominal cavity. The actual incidence of the latter complication is ~10%. The removal of lost stones from the abdominal cavity is rather elaborate if not infeasible. There is little information about the behaviour of retained gallstones in the free abdominal cavity. Publications report on subsequent intraperitoneal abscesses and fistulas or on the extreme localization of the impacted gallstones. This paper presents two cases with late complications of the abandoned gallstones or gallbladder. Case 1: A 56-year-old female patient underwent an LC 7 years ago. She was recently admitted with a chronic septic condition and suspected autoimmune disease. Preoperative examinations indicated hepatic abscess. Surgery showed gallstones impacted in the gallbladder bed. Case 2: A 59-year-old male patient underwent an LC a year before his admission. His operation was followed by the development of a septic condition and a subphrenic abscess was identified. During his reoperation, a remnant gallbladder containing bile stones was found and removed. Special attention should be paid to careful revision of residual stones during LC.
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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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Jani K, Rajan PS, Sendhilkumar K, Palanivelu C. Twenty years after Erich Muhe: Persisting controversies with the gold standard of laparoscopic cholecystectomy. J Minim Access Surg 2006; 2:49-58. [PMID: 21170235 PMCID: PMC2997273 DOI: 10.4103/0972-9941.26646] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 02/15/2006] [Indexed: 12/22/2022] Open
Abstract
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease.
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Affiliation(s)
- Kalpesh Jani
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - P S Rajan
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - K Sendhilkumar
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - C Palanivelu
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
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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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Woodfield JC, Rodgers M, Windsor JA. Peritoneal gallstones following laparoscopic cholecystectomy. Surg Endosc 2004; 18:1200-7. [PMID: 15457378 DOI: 10.1007/s00464-003-8260-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gallstone spillage during laparoscopic cholecystectomy (LC) is a common intraoperative event. Although gallstones left in the peritoneal cavity were initially considered harmless, a significant number of complications have been reported. Our aim was to quantify the likelihood, and to document the range, of subsequent complications. METHODS A Medline search from 1987 to January 2003 was performed. Articles with more than 500 LCs that quantified the frequency of complications due to peritoneal gallstones were reviewed, as were representative case studies of different stated complications. RESULTS Six studies, covering 18,280 LCs, were found. The incidence of gallbladder perforation was 18.3%, that of gallstone spillage was 7.3%, and that of unretrieved peritoneal gallstones was estimated to be 2.4%. There were 27 patients with complications. The likelihood of a complication when gallstone spillage occurred was 2.3%, which increased to 7.0% when unretrieved peritoneal gallstones were documented. CONCLUSION Spilt gallstones have a small but quantifiably real risk of causing a wide range of significant postoperative problems.
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Affiliation(s)
- J C Woodfield
- HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Park Road, 92024, Private Bag, Auckland, New Zealand
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Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL. Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. Postgrad Med J 2004; 80:77-9. [PMID: 14970293 PMCID: PMC1742934 DOI: 10.1136/pmj.2003.006023] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic cholecystectomy is associated with spillage of gall stones in 5%-40% of procedures, but complications occur very rarely. There are, however, isolated case reports describing a range of complications occurring both at a distance from and near to the subhepatic area. This review looks into the various modes of presentation, ways to minimise spillage, treating the complications, and the legal implications.
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Affiliation(s)
- T Sathesh-Kumar
- Department of Surgery, University Hospital of North Durham, Durham, UK.
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Conze J, Böhm G, Niggemann P, Steinau G, Schumpelick V. Venocutaneous fistula. Surg Endosc 2004; 17:2028-31. [PMID: 14973752 DOI: 10.1007/s00464-003-4221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 04/16/2003] [Indexed: 10/26/2022]
Abstract
This is the first description of venocutaneous fistula, a late complication of elective laparoscopic cholecystectomy that arose 18 months after the initial operation. Postoperatively, the patient twice developed an abscess in the abdominal wall at the former site of the umbilical trocar. The first abscess occurred on the 6th postoperative day; the second, after 14 months. After an additional 4 months, a fistula opening appeared just below the umbilicus. Fistulography revealed a connection with the venous system of the omentum majus. During subsequent resection of the fistula, a pigment gallstone was retrieved from the base of the fistula.
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Affiliation(s)
- J Conze
- Department of Surgery, Rhenisch Westphalian Technical University, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Hazrah P, Oahn KTH, Tewari M, Pandey AK, Kumar K, Mohapatra TM, Shukla HS. The frequency of live bacteria in gallstones. HPB (Oxford) 2004; 6:28-32. [PMID: 18333042 PMCID: PMC2020648 DOI: 10.1080/13651820310025192] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Septic complications reported from stones and concretions lost in the peritoneal cavity following laparoscopic cholecystectomy reflect the infective potential of gallstones. Although bacteria have been demonstrated in the core of gallstones by scanning electron microscopy and molecular genetic techniques, gallstone culture is the only conclusive proof of whether such bacteria are viable and can cause infection. METHODS Gallstones retrieved from patients undergoing cholecystectomy were decontaminated after surface cleaning with alcohol, and each core was scooped for culture. RESULTS In this study organisms were cultured from the cores of gallstones in 81% of cases of cholelithiasis and 77% of cases of gallbladder carcinoma, irrespective of stone type and size. Both enteric (57.5%) and non-enteric (20%) organisms were isolated in cholelithiasis, whereas only enteric bacteria could be cultured from cases of gallbladder carcinoma. Long thought to be a causative agent, Salmonella organisms were detected in none of the 14 cases of gallbladder carcinoma. CONCLUSION Contrary to the popular belief that bacteria inside gallstones are dead, gallstones from most patients contain live bacteria with the potential to cause infective complications.
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Affiliation(s)
- P Hazrah
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - KTH Oahn
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - M Tewari
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - AK Pandey
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - K Kumar
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - TM Mohapatra
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
| | - HS Shukla
- Department of Surgery and Microbiology, Institute of Medical Sciences, Banaras Hindu UniversityVaranasi 221005India
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