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Koichopolos J, Hamidi M, Cecchini M, Leslie K. Gastric outlet obstruction by a lost gallstone: Case report and literature review. Int J Surg Case Rep 2017; 41:128-131. [PMID: 29073549 PMCID: PMC5655411 DOI: 10.1016/j.ijscr.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Spilled gallstones from a laparoscopic cholecystectomy can be a source of significant morbidity, most commonly causing abscesses and fistulae. Preventative measures for loss, careful removal during the initial surgery, and good documentation of any concern for remaining intraperitoneal stones needs to be performed with the initial surgery. CASE REPORT An 80-year-old male with a history of complicated biliary disease resulting in a cholecystectomy presented to general surgery clinic with increasing symptoms of gastric outlet obstruction. CT imaging was concerning for a malignant process despite negative biopsies. A distal gastrectomy and Billroth II reconstruction was performed and final pathology showed dense inflammation with a single calcified stone incarcerated within the gastric wall of the inflamed pylorus and no malignancy. DISCUSSION Stones lost during laparoscopic cholecystectomy are not innocuous and preventative measures for loss, careful removal during the initial surgery, and good documentation of any concern for remaining intraperitoneal stones. CONCLUSION This is the first case of gastric outlet obstruction caused by an intramural obstruction of the pylorus from a spilled gallstone during a laparoscopic cholecystectomy and subsequent inflammation. This is an etiology that must be considered in new cases of gastric outlet obstruction and can mimic malignancy.
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Affiliation(s)
- Jennifer Koichopolos
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Moska Hamidi
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew Cecchini
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kenneth Leslie
- Department of Surgery, London Health Sciences Center, London, ON, Canada
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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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Kim BS, Joo SH, Kim HC. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy. World J Gastroenterol 2016; 22:4421-4426. [PMID: 27158213 PMCID: PMC4853702 DOI: 10.3748/wjg.v22.i17.4421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/21/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.
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Gaster RS, Berger AJ, Ahmadi-Kashani M, Shrager JB, Lee GK. Chronic cutaneous chest wall fistula and gallstone empyema due to retained gallstones. BMJ Case Rep 2014; 2014:bcr-2013-010159. [PMID: 25123567 DOI: 10.1136/bcr-2013-010159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 72-year-old man who presented with a persistent pleural effusion and painful abscess in the right lower chest wall 6 months following a laparoscopic cholecystectomy. The patient subsequently developed a chronic cutaneous chest wall fistula requiring a large resection and complex closure. The complication was likely secondary to intraoperative spillage of gallstones. While previous reports describe gallstone spillage in the abdominal cavity as benign, this case illustrates that stones left in the abdominal cavity can potentially lead to significant morbidity. Therefore, stones should be diligently removed from the abdominal cavity when spillage occurs. In addition, it is important that operative notes reflect the occurrence of stone spillage so stones may be suspected when a patient presents with an abdominal or thoracic infection following a cholecystectomy.
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Noda Y, Kanematsu M, Goshima S, Kondo H, Watanabe H, Kawada H, Kawai N, Tanahashi Y. Peritoneal chronic inflammatory mass formation due to gallstones lost during laparoscopic cholecystectomy. Clin Imaging 2014; 38:758-61. [PMID: 24852678 DOI: 10.1016/j.clinimag.2014.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/26/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
We here describe the radiologic findings of peritoneal chronic abscess formation due to gallstones lost within the peritoneum during laparoscopic cholecystectomy (LC). A radiologic workup 7 months after LC revealed a soft-tissue mass with contrast enhancement, harboring internal necrosis and punctate calcium located in the Morrison's pouch. The mass exhibited restricted water molecule diffusion, absence of fat deposition, and increased F-18 fluorodeoxy-D-glucose uptake, thus mimicking a malignant tumor. The biopsy revealed an inflammatory granuloma. Another patient with similar findings was treated with percutaneous abscess drainage. Thus, radiologists should be aware of this disease condition and its imaging findings.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Satoshi Goshima
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Kondo
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Haruo Watanabe
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
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Out of Sight but Kept in Mind: Complications and Imitations of Dropped Gallstones. AJR Am J Roentgenol 2013; 200:1244-53. [DOI: 10.2214/ajr.12.9430] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Irkorucu O, Tascilar O, Emre AU, Çakmak GK, Ucan BH, Comert M. Missed gallstones in the bile duct and abdominal cavity: a case report. Clinics (Sao Paulo) 2008; 63:561-4. [PMID: 18719774 PMCID: PMC2664139 DOI: 10.1590/s1807-59322008000400027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Intra-abdominal spilled gallstones simulating peritoneal metastasis: CT and MR imaging features (2008: 1b). Eur Radiol 2008; 18:851-4. [DOI: 10.1007/s00330-007-0703-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
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Verma GR, Kaman L. Gastro Cutaneous Fistula After Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2006; 16:165-6. [PMID: 16804460 DOI: 10.1097/00129689-200606000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A young lady presented with a nonhealing epigastric sinus after 2 years of laparoscopic cholecystectomy performed outside. Upper gastrointestinal (GI) endoscopy and contrast study confirmed its communication with the stomach. At relaparoscopy, the fistula was identified, dissected, and stapled with endo-GIA stapler. Patient made an uneventful postoperative recovery and she is well after 20 months of surgery. It may be concluded that laparoscopic cholecystectomy can lead to the development of gastrocutaneous fistula that can be managed by relaparoscopy and stapling the tract with endo-GIA devices.
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Affiliation(s)
- Ganga R Verma
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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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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Shamiyeh A, Wayand W. Current status of laparoscopic therapy of cholecystolithiasis and common bile duct stones. Dig Dis 2005; 23:119-26. [PMID: 16352891 DOI: 10.1159/000088593] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. METHODS A Medline, PubMed, Cochrane search. RESULTS Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is 'therapeutic splitting' with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. CONCLUSION The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.
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Affiliation(s)
- Andreas Shamiyeh
- Ludwig Boltzmann Institute for Operative Laparoscopy and Second Surgical Department, Academic Teaching Hospital, Linz, Austria.
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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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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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Atri M, Bonifacio A, Ryan M, Pilleul FL, Hanbidge A, Clark J, Murphy J. Dropped gallstones post laparoscopic cholecystectomy mimicking peritoneal seeding: CT and ultrasound features. J Comput Assist Tomogr 2002; 26:1000-5. [PMID: 12488750 DOI: 10.1097/00004728-200211000-00025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this work was to investigate the ultrasound (US) and CT features of dropped gallstones mimicking peritoneal seeding in patients after laparoscopic cholecystectomy (LCC). METHOD We describe the US and CT features of dropped gallstones mimicking peritoneal seeding in eight patients who underwent LCC. We also conducted a retrospective study of consecutive LCC patients who subsequently had CT to determine the prevalence of this condition. RESULTS AND CONCLUSION The density of dropped gallstones on CT ranged from hypodense to partially or completely calcified nodules. Some stones did not have visible surrounding reaction, whereas others showed an enhancing halo. All stones were echogenic and demonstrated shadowing on US. The stones were located mostly on the right side of the abdomen, and the majority were around the liver. The prevalence of dropped gallstones post laparoscopic cholecystectomy was 4.2%.
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Affiliation(s)
- Mostafa Atri
- Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Center, Sunnybrook Campus, MG 130A, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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Papasavas PK, Caushaj PF, Gagné DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2002; 12:383-6. [PMID: 12470414 DOI: 10.1089/109264202320884144] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spilled gallstones have emerged as a new issue in the era of laparoscopic cholecystectomy. We treated a 77-year-old woman who underwent laparoscopic cholecystectomy. Subsequently, a right flank abscess developed. During the cholecystectomy, the gallbladder was perforated and stones were spilled. After a failed attempt to drain the abscess percutaneously, the patient required open drainage, which revealed retained gallstones in the right flank. The abscess resolved, although the patient continued to have intermittent drainage without evidence of sepsis. Review of the literature revealed 127 cases of spilled gallstones, of which 44.1% presented with intraperitoneal abscess, 18.1% with abdominal wall abscess, 11.8% with thoracic abscess, 10.2% with retroperitoneal abscess, and the rest with various clinical pictures. In case of gallstone spillage during laparoscopic cholecystectomy, every effort should be made to locate and retrieve the stones.
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Affiliation(s)
- Pavlos K Papasavas
- Temple University Clinical Campus at The Western Pennsylvania Hospital, Department of Surgery, Pittsburgh, Pennsylvania 15224, USA.
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Famulari C, Pirrone G, Macrì A, Crescenti F, Scuderi G, De Caridi G, Giuseppe AL. The vesical granuloma: rare and late complication of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2001; 11:368-71. [PMID: 11822861 DOI: 10.1097/00129689-200112000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The spillage of gallstones into the peritoneal cavity from iatrogenic perforation of the gallbladder that occurs during laparoscopic cholecystectomy can result in late and serious complications. We report a case of vesical granuloma with symptoms of dysuria, pollakiuria, and vesical tenesmus that occurred 23 months after a laparoscopic cholecystectomy. Preoperative diagnostic evaluation showed a 3-cm vesical neoformation. A partial cystectomy was performed; macroscopic and histologic examination documented a central nidus of fragmented gallstones and a picture of chronic granulomatous inflammation. Although complications related to unretrieved gallstones that spill into the peritoneal cavity during laparoscopic cholecystectomy are rare, they are being reported with increasing frequency. Therefore, it is important to use tools and techniques that prevent lacerations of the gallbladder and involve retrieval of spilled gallstones.
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Affiliation(s)
- C Famulari
- Department of Emergency Surgery, University of Messina, Italy.
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Yao CC, Wong HH, Yang CC, Lin CS. Abdominal wall abscess secondary to spilled gallstones: late complication of laparoscopic cholecystectomy and preventive measures. J Laparoendosc Adv Surg Tech A 2001; 11:47-51. [PMID: 11444325 DOI: 10.1089/10926420150502959] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spilled gallstones left in the abdominal cavity or trapped at trocar sites may cause considerable morbidity. We saw a patient with an abdominal wall abscess 2 years after laparoscopic cholecystectomy secondary to spilled stones. After we reviewed the operative procedure in addition to the accumulated experience in laparoscopic surgery, we believe that retrieval of specimens and their contents is of paramount importance, especially when the gallbladder is infected, contains several stones, or may harbor malignancy. Therefore, we made use of a simple surgical glove with a long pursestring suture surrounding the opening to collect the specimen. This method proved to be simple and quite convenient, with the needed materials readily available. It can collect the spilled stones within the abdominal cavity as well as the gallbladder and can transport these stones out of the abdominal cavity with ease and safety. It also protects the specimen in contact with the wound and cuts short the operating time. The technique and advantages are described.
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Affiliation(s)
- C C Yao
- Department of Surgery, Min-Shen General Hospital, Taoyuan, Taiwan, Republic of China.
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Spontaneous Hepatic Hemorrhage Secondary to Retained Intraperitoneal Gallstones. Am Surg 2000. [DOI: 10.1177/000313480006601116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We describe the first reported case of spontaneous hepatic hemorrhage as a result of retained gallstones in the region of Morison's pouch eroding into the liver parenchyma. The patient presented with acute right upper quadrant abdominal pain 7 months after laparoscopic cholecystectomy. She sustained an episode of limited spontaneous hepatic hemorrhage as noted by abdominal sonography, computerized tomography, and a 4-g/dL hemoglobin drop. Laparoscopic exploration revealed the source of hemorrhage to be an inflammatory source created by retained intraperitoneal gallstones.
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