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Kendera W, Shroff N, Al-Jabbari E, Barghash M, Bagherpour A, Bhargava P. "Target sign" from dropped gallstones after laparoscopic cholecystectomy. Radiol Case Rep 2021; 17:23-26. [PMID: 34760036 PMCID: PMC8567157 DOI: 10.1016/j.radcr.2021.09.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Isolated case reports and small series in radiologic and surgical literature relay the different modes of clinical presentation that arise secondary to spillage of gallstones during surgery. We report a case of a 70-year-old female who presented with a 2-week history of right-sided abdominal pain. CT (computerized tomography) imaging findings demonstrated multiple peripherally enhancing hypoattenuating lesions in the right subphrenic space abutting the hepatic dome, concerning for abscesses. The lesions were found to have a characteristic central hyperattenuating focus (Target Sign) consistent with gallstones, as identified on a pre-cholecystectomy CT, resulting in the early diagnosis and treatment of dropped gallstones from prior laparoscopic cholecystectomy approximately 1 year prior to presentation.
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Affiliation(s)
- Wendy Kendera
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Neel Shroff
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Esraa Al-Jabbari
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Maggie Barghash
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Arya Bagherpour
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd, UTMB, Galveston, TX, 77555
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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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Tiang KW, So HF, Hwang Y, Siddaiah-Subramanya M. Free Intraperitoneal Gallstone: An Unusual Case of Small Bowel Obstruction from Extrinsic Compression. Case Rep Surg 2018; 2018:1341572. [PMID: 29535884 PMCID: PMC5817355 DOI: 10.1155/2018/1341572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/14/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is preferred in the treatment of symptomatic cholecystolithiasis. Gallstone spillage is not uncommon, and there have been reports of associated complications. We report a case of a free intraperitoneal gallstone, left inadvertently during LC, which developed an inflammatory phlegmon with abscess containing gallstone, causing extraluminal compression on the distal ileum, resulting in small bowel obstruction. This complication in particular is almost unheard of. The patient underwent laparoscopic drainage of abscess and retrieval of gallstone, which relieved the obstruction. Clinicians, therefore, need to keep an open mind in the workup for bowel obstruction. During LC, gallstone spillage should be prevented and retrieved whenever possible to minimize early and late complications associated with it.
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Affiliation(s)
- Kor Woi Tiang
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- Griffith University, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Hang Fai So
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Yang Hwang
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Manjunath Siddaiah-Subramanya
- Department of Surgery, Logan Hospital, Meadowbrook, QLD, Australia
- Griffith University, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
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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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An ectopic biliary calculus mimicking gastric neoplasm: A late complication of spilled gallstones. Surgery 2015; 159:668-9. [PMID: 26395505 DOI: 10.1016/j.surg.2014.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022]
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Bedell SL, Kho KA. Spilled gallstones after laparoscopic cholecystectomy associated with pelvic pain. Am J Obstet Gynecol 2015; 213:432.e1-2. [PMID: 25912299 DOI: 10.1016/j.ajog.2015.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/14/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
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Pazouki A, Abdollahi A, Mehrabi Bahar M, Jangjoo A, Pezeshki Rad M, Aliakbarian M, Jabbari Nooghabi M. Evaluation of the Incidence of Complications of Lost Gallstones During Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2014; 24:213-5. [DOI: 10.1097/sle.0b013e31828fc09e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Abstract
BACKGROUND A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications. METHODS 129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications. RESULTS T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others. CONCLUSIONS Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.
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Vyas JM, Kasmar A, Chang HR, Holden J, Hohmann E. Abdominal Abscesses Due to Actinomycosis after Laparoscopic Cholecystectomy: Case Reports and Review. Clin Infect Dis 2007; 44:e1-4. [PMID: 17173208 DOI: 10.1086/510077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 09/11/2006] [Indexed: 11/03/2022] Open
Abstract
We describe 2 patients who presented to a health care facility with abdominal abscesses years after undergoing laparoscopic cholecystectomy that was complicated by gallstone spillage. In both patients, sample cultures yielded Actinomyces species and enteric organisms. In 1 patient, crystallographic analysis of abscess debris confirmed the presence of gallstones. Actinomyces species is a rare cause of abdominal abscesses that should be considered in this patient population.
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Affiliation(s)
- Jatin M Vyas
- Infectious Diseases Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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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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Roberts DJ, Chun HM. Dropped Gallstone as a Nidus of Intra-abdominal Abscess Complicated by Empyema. Clin Infect Dis 2005; 41:e64-6. [PMID: 16107971 DOI: 10.1086/432892] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/24/2005] [Indexed: 11/03/2022] Open
Abstract
We describe a patient who developed an intra-abdominal abscess and empyema from a dropped gallstone at the time of laparoscopic cholecystectomy 1.5 years ago. As minimally invasive surgeries become conventional, clinicians should be aware of this increasingly common complication.
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Affiliation(s)
- Dustin J Roberts
- Division of Internal Medicine, Naval Medical Center, Portsmouth, Virginia, USA
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Tumer AR, Yüksek YN, Yasti AC, Gözalan U, Kama NA. Dropped gallstones during laparoscopic cholecystectomy: the consequences. World J Surg 2005; 29:437-40. [PMID: 15770380 DOI: 10.1007/s00268-004-7588-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences.
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Affiliation(s)
- Ali Riza Tumer
- Department of Forensic Medicine, Clinical Forensic Sciences, Hacettepe University School of Medicine, 3 Cad. 48. Sokak 5/3, 06510 Bahcelievler, Ankara, Turkey.
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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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Sonographic features of intra-abdominal abscess caused by spilled stones during laparoscopic cholecystectomy. J Med Ultrason (2001) 2003; 30:233-9. [PMID: 27278410 DOI: 10.1007/bf02481286] [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: 12/12/2002] [Accepted: 04/23/2003] [Indexed: 10/24/2022]
Abstract
Spillage of stones into the abdominal cavity resulting from perforation of the gallbladder is one of the common complications of laparoscopic cholecystectomy. Although many surgeons know that stones left in the abdominal cavity can cause late visceral abscess requiring surgical treatment, the sonographic features of such abscesses have not yet to be thoroughly investigated. We investigated the sonographic features of intra-abdominal abscesses caused by spilled stones after laparoscopic cholecystectomy using Hitachi Model EUB-525 (3.5 MHz) and Aloka Model SSD-5500 (3.75 MHz) ultrasound systems. Two thousand thirty-six laparoscopic cholecystectomy procedures were carried out at this institution from 1990 through 2001. During this period, we encountered seven cases of intra-abdominal abscess. Three of these cases were symptomatic, but abscess, granulation, or both, were found incidentally by ultrasonography in the other four patients during routine annual health examinations. Laparotomy and open drainage of pus and gallstones from the intra-abdominal abscess were necessary in five cases. Ultrasonography revealed a mass in six of the seven patients. The abscesses were located in either the right subphrenic or subhepatic space on the surface of the liver and were sometimes difficult to distinguish from liver tumors. Ultrasound showed the abscesses as oval, low-echoic, solid masses with posterior enhancement. They ranged from 20 to 58 mm in diameter, had clear margins and highly echoic peripheral rims, and showed lateral shadowing. The lesions also contained several highly echoic spots with acoustic shadows that were thought to be the spilled stones. We conclude that visceral abscess should be considered after laparoscopic cholecystectomy, and that careful observation using ultrasonography is required, especially when the gallbladder is perforated and bile and stones have spilled out.
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Coelho JCU, Aranha Junior AA, Mantovannni L. Abscesso intrabdominal tardio pós colecistectomia laparoscópica. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
This case report describes a subhepatic abscess from spilled gallstones which eroded through the diaphragm causing a right lower lobe pulmonary abscess and presenting as massive hemoptysis.
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Affiliation(s)
- Y B Werber
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston 02114, USA
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Retroperitoneal Abscess After Retained Stones During Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2000. [DOI: 10.1097/00129689-200004000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Castro MG, Alves AS, Oliveira CA, Vieira Júnior A, Vianna JL, Costa RF. Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy. REVISTA DO HOSPITAL DAS CLINICAS 1999; 54:209-12. [PMID: 10881069 DOI: 10.1590/s0041-87811999000600007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10% - 32%), with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2% - 20%). Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.
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Affiliation(s)
- M G Castro
- Division of General Surgery, Felício Rocho Hospital, Belo Horizonte, Brazil
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Weber A, Vazquez J, Valencia S, Cueto J. Surg Laparosc Endosc Percutan Tech 1998; 8:457-459. [DOI: 10.1097/00019509-199812000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Perforation and spillage of gallstones is a common occurrence in laparoscopic cholecystectomies. The long-term complications of these stones remains controversial. Experimental studies have been carried out to elucidate the outcome of intraperitoneal gallstones, but the chemical composition of these stones has not been considered in previous studies. In this study, we investigated the local effects of intraperitoneal gallstones in rats with respect to their chemical composition. Bile and gallstones were taken from human cholecystectomy specimens, and sent for bacteriologic and chemical analysis. Twenty cholesterol and 10 pigment stones were placed in the abdominal cavity of rats. Long-term local effects of gallstones were determined at the end of 3 months with macroscopic and microscopic examination. The fragments of two pigment stones were infected by Staphylococcus aureus. Five (17%) cholesterol stones were found free in the abdominal cavity, and 25 stones (83%) were wrapped with adjacent structures. Granuloma formation was found around 4 pigment stones (13% of all stones, 40% of pigment stones; p = 0.0077). We observed large granulomas and cutaneous fistula formation in two rats with infected pigment stones placed in the abdominal cavity. Histhopathologic examination also showed significantly severe inflammatory reactions secondary to pigment stones (p<0.001). In conclusion our findings revealed that chemical composition has a significant influence on the fate of intraabdominal gallstones, and infection may aggravate local reactions and complications. Based on our findings, laparoscopic retrieval of spilled stones whenever possible seems to be useful to prevent subsequent infectious complications and inflammatory reactions. Patients with retained intraperitoneal pigment stones after laparoscopic cholecystectomy must be followed up closely.
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