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Husnain A, Reiland A, Nemcek AA, Salem R, Nagle AP, Teitelbaum E, Riaz A. Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series. Surg Laparosc Endosc Percutan Tech 2024:00129689-990000000-00225. [PMID: 38736370 DOI: 10.1097/sle.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/21/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition. MATERIALS AND METHODS We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.5 years [68 to 82]) presenting with recurrent or chronic intra-abdominal abscesses secondary to dropped gallstones. Technical success was defined as the visualization and retrieval of all stones. DGs were identified on pre-procedure imaging. Number of abscesses recurrence was 12 (1/6), 1 (3/6), and 0 (2/6) with a median interval of 2 months (1 to 21) between cholecystectomy and abscess development. RESULTS Percutaneous endoscopy and fluoroscopy guidance were utilized in all cases. Technical success was achieved in 4 patients (66%). The median procedure time was 65.8 minutes (39 to 136). The median fluoroscopy time and dose were 12.6 min (3.3 to 67) and 234 mGy (31 to 1457), respectively. There were no intraprocedure and postprocedure complications. No abscess recurrence was reported among successful procedures during a median follow-up of 193 days (51 to 308). CONCLUSION Percutaneous image and endoscopy-guided lithotripsy/lithectomy are safe and effective. This technique is a suitable alternative to open surgery for dropped gallstones. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Ali Husnain
- Department of Radiology, Section of Interventional Radiology
| | - Allison Reiland
- Department of Radiology, Section of Interventional Radiology
| | - Albert A Nemcek
- Department of Radiology, Section of Interventional Radiology
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology
| | | | - Ezra Teitelbaum
- Department of Surgery, Northwestern Memorial Hospital, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology
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2
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Nezami N, Behbahani K, Elwood DR, Greene WR, Majdalany BS, Shaikh J. Percutaneous endoscopy (peritoneoscopy) and lithotripsy for retrieval of dropped gallstones post-cholecystectomy. Clin Endosc 2022; 55:819-823. [PMID: 36464829 PMCID: PMC9726428 DOI: 10.5946/ce.2021.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA,Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA,Correspondence: Nariman Nezami Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street N2E23, Baltimore, MD 21201, USA E-mail:
| | - Keywan Behbahani
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David R. Elwood
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy R. Greene
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Bill S. Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jamil Shaikh
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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3
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Abi El Cheikh T, Vargas IM, Alili E, Tiesenga F. The Improvement of Nonspecific Chronic Symptoms Post-Gallbladder Clip Removal. Cureus 2022; 14:e30625. [DOI: 10.7759/cureus.30625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
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4
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Salati SA, Alfehaid M, Alsuwaydani S, AlSulaim L. Spilled gallstones after laparoscopic cholecystectomy: a systematic review. POLISH JOURNAL OF SURGERY 2022; 95:1-20. [PMID: 36805307 DOI: 10.5604/01.3001.0015.8571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 20122022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.
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Affiliation(s)
- Sajad Ahmad Salati
- Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia
| | - Mohammed Alfehaid
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
| | - Saleh Alsuwaydani
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
| | - Lamees AlSulaim
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
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5
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Hey, you forgot something! The Management of Symptomatic Retained Gallstones. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2021.100052] [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] Open
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6
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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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7
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Imaging of Postoperative Biliary Complications. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00368-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Elmohr MM, Elsayes KM, Pickhardt PJ. Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging. Br J Radiol 2020; 93:20200401. [PMID: 32516560 DOI: 10.1259/bjr.20200401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.
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Affiliation(s)
- Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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9
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Sato S, Inoue A, Ota S, Furukawa A, Miyagawa Y, Wakamiya M, Hirose T, Furuichi K, Watanabe Y. Foreign-body granulomas and abscesses caused by dropped gallstones after cholecystectomy: Four cases diagnosed with multimodality imaging. Radiol Case Rep 2020; 15:1480-1484. [PMID: 32670445 PMCID: PMC7339004 DOI: 10.1016/j.radcr.2020.05.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Four cases (age range, 60-78 years, male:female = 1:3) who had undergone cholecystectomy presented with fever (n = 1), right abdominal pain with fever (n = 1), appetite loss with fever (n = 1), and absence of symptoms (n = 1). Computed tomography (CT) showed an irregular-shaped invasive mass or fluid collection in the right Morrison's pouch, right paracolic gutter, gallbladder fossa, subphrenic space, or abdominal wall. CT and ultrasound revealed gallstones in the granuloma in 3 cases and an abscess in one case. The inflammatory process induced by dropped gallstones may mimic peritoneal malignancies. Awareness of cholecystectomy and the detection of gallstones in the lesion are essential for the diagnosis of dropped gallstones.
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Affiliation(s)
- Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, 7-2-1, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Yoshihiro Miyagawa
- Department of Radiology, Nagahama City Hospital, 313, Oinui-cho, Nagahama-city, Shiga, 526-8580, Japan
| | - Makoto Wakamiya
- Department of Radiology, Nagahama City Hospital, 313, Oinui-cho, Nagahama-city, Shiga, 526-8580, Japan
| | - Tomohiro Hirose
- Department of Radiology, SaiseikaiNoe Hospital, 1-3-25, Furuichi, Joto-ku, Osaka-city, Osaka, 536-0001, Japan
| | - Kenji Furuichi
- Department of Radiology, SaiseikaiNoe Hospital, 1-3-25, Furuichi, Joto-ku, Osaka-city, Osaka, 536-0001, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu-city, Shiga, 520-2192, Japan
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10
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Jamil Y, Reading DN. Learning from the radiological findings of dropped gall stone and/or appendicolith (its complication and management strategy). BJR Case Rep 2019; 5:20180096. [PMID: 31501704 PMCID: PMC6726179 DOI: 10.1259/bjrcr.20180096] [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: 08/23/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 11/05/2022] Open
Abstract
This case report the patient presented with intra-abdominal abscess with the past surgical history of laparoscopic cholecystectomy and appendectomy. Being a radiologist, it is important to keep patient’s previous surgical interventions in mind as it can change the management options.
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Affiliation(s)
- Yasir Jamil
- Department of Clinical Radiology, Whipps Cross University Hospital, London, UK
| | - Dr Nicholas Reading
- Department of Clinical Radiology, Whipps Cross University Hospital, London, UK
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11
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Singh SC, Weber F, Meyers AB, Reyes C, Epelman M. Perihepatic abscesses caused by dropped appendicoliths in a child. Radiol Case Rep 2018; 14:1-5. [PMID: 30294402 PMCID: PMC6168925 DOI: 10.1016/j.radcr.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 01/07/2023] Open
Abstract
A dropped appendicolith is a well-known complication of laparoscopic appendectomy that may occur because of stone expulsion from the appendix, before or during surgery, and typically manifests as a focal, subcentimeter area of high attenuation with or without associated abscess. Dropped appendicoliths may act as niduses for infection and may result in the future development of abscess formation. We report the case of a 10-year-old pediatric patient who developed 2 perihepatic abscesses caused by 2 appendicoliths that were inadvertently dropped during laparoscopic surgery.
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Affiliation(s)
- Suprit C Singh
- University of Central Florida, College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827, USA
| | - Fabiola Weber
- University of Central Florida, College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827, USA.,Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
| | - Arthur B Meyers
- University of Central Florida, College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827, USA.,Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
| | - Cynthia Reyes
- Department of Pediatric Surgery, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
| | - Monica Epelman
- University of Central Florida, College of Medicine, 6850 Lake Nona Blvd., Orlando, FL 32827, USA.,Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827, USA
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12
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Total Hip Lithiasis: A Rare Sequelae of Spilled Gallstones. Case Rep Orthop 2018; 2018:9706065. [PMID: 30013805 PMCID: PMC6022300 DOI: 10.1155/2018/9706065] [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: 02/10/2018] [Accepted: 05/02/2018] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic cholecystectomy is a surgical treatment for acute cholecystitis or symptomatic cholelithiasis. One potential complication, the spillage of gallstones into the peritoneal cavity, can form a nidus for infection and may be associated with hepatic, retroperitoneal, thoracic, and abdominal wall abscesses. We report a case of a patient presenting with a right iliopsoas abscess and an infected right hip prosthesis status postlaparoscopic cholecystectomy. A CT demonstrated that the acetabular shell was overmedialized and perforated through the medial wall. The patient was taken to the operating room for explantation of components. A collection of gallstones was identified deep to the acetabulum during the explantation. The case highlights the importance of avoiding overmedialization of the acetabular component, which can provide a direct route for infection into the hip joint.
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13
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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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14
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Immediate postoperative pain: an atypical presentation of dropped gallstones after laparoscopic cholecystectomy. Case Rep Surg 2015; 2015:930450. [PMID: 25649178 PMCID: PMC4310319 DOI: 10.1155/2015/930450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/15/2014] [Indexed: 01/16/2023] Open
Abstract
Cholecystectomy is one of the most commonly performed surgical procedures in the United States. A common complication is dropped gallstones, and the diversity of their presentation poses a substantial diagnostic challenge. We report the case of a 58-year-old man presenting with chronic right upper quadrant hours status post cholecystectomy. Imaging demonstrated retained gallstones in the perihepatic space and symptoms remitted following their removal via laparoscopic operation. Gallstones are lost in roughly 1 in 40 cholecystectomies and are usually asymptomatic. The most common presentations are months or years status post cholecystectomy due to fistula, abscess, or sinus tract formation. We report this case hoping to bring light to a rare presentation for dropped gallstones and provide advice on the management of this common complication of cholecystectomy.
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15
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Mimickers of neoplasm on abdominal and pelvic CT. ACTA ACUST UNITED AC 2014; 40:400-10. [PMID: 25123077 DOI: 10.1007/s00261-014-0216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The radiologist can encounter benign significant imaging findings on computed tomography that can be incorrectly interpreted as neoplasm. The authors review several benign findings and demonstrate several methods to differentiate these findings from more sinister pathology. CONCLUSION It is imperative for the radiologist to be cognizant of and how to correctly identify mimickers of pathology so that unnecessary interventions and surgeries are avoided.
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16
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Nayak L, Menias CO, Gayer G. Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. Br J Radiol 2013; 86:20120588. [PMID: 23747395 DOI: 10.1259/bjr.20120588] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Spillage of gallstones into the abdominal cavity, referred to as "dropped gallstones" (DGs), occurs commonly during laparoscopic cholecystectomy. The majority of these spilled stones remain clinically silent; however, if uncomplicated DGs are not correctly identified on subsequent imaging, they may mimic peritoneal implants and cause unduly concern. A small percentage of DGs cause complications, including abscess and fistula formation. Recognising the DG within the abscess is critical for definitive treatment. This pictorial review illustrates the imaging appearances and complications of DGs on CT, MRI and ultrasound and emphasises pitfalls in diagnosis.
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Affiliation(s)
- L Nayak
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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17
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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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18
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Little M, Munipalle PC, Nugud O. A rare late complication of laparoscopic cholecystectomy. BMJ Case Rep 2013; 2013:bcr-2013-009070. [PMID: 23605831 DOI: 10.1136/bcr-2013-009070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 86-year-old woman presented three years after laparoscopic cholecystectomy with right upper quadrant pain and raised inflammatory markers. Liver function tests were normal; however, a previous ultrasound scan suggested a common bile duct stone so she was treated for cholangitis secondary to choledocholithiasis. Repeat ultrasound scan again showed a common bile duct (CBD) stone and also a subdiaphragmatic abscess. CT scan confirmed the abscess, associated with a surgical clip from her previous surgery. There was no evidence of a persistent CBD stone on the CT scan. She was treated conservatively with intravenous antibiotics and her symptoms improved. Follow-up MRI did not show any choledocholithiasis. Surgical clips causing delayed abscess formation are very unusual. We discuss the presentation, investigations and treatment of this interesting case. Existing relevant literature is reviewed, and management strategies to treat such rare complications are suggested.
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Affiliation(s)
- Mhairi Little
- Department of General Surgery, Friarage Hospital, Northallerton, UK
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19
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Greenfield NP, Azziz AS, Jung AJ, Yeh BM, Aslam R, Coakley FV. Imaging late complications of cholecystectomy. Clin Imaging 2012; 36:763-7. [PMID: 23154007 DOI: 10.1016/j.clinimag.2012.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To review the imaging findings in late complications of cholecystectomy. CONCLUSIONS Late postcholecystectomy complications include papillary stenosis, choledocholithiasis, biliary stricture, remnant gallbladder, and dropped gallstones. Such complications can cause substantial morbidity, and knowledge of the imaging appearances can facilitate expeditious diagnosis and treatment.
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Affiliation(s)
- Nava P Greenfield
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA
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20
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Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech 2012; 22:226-31. [PMID: 22678318 DOI: 10.1097/sle.0b013e31824f25cd] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. METHODS The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined-patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. RESULTS Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n=30) or the knot-tying (polyglactin) suture group (n=31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P>0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27 ± 12.2 min) was shorter than that for the knot-tying group (62.81 ± 15.4 min) (P=0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P>0.05). CONCLUSIONS In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.
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Gayer G, Petrovitch I, Jeffrey RB. Foreign objects encountered in the abdominal cavity at CT. Radiographics 2011; 31:409-28. [PMID: 21415187 DOI: 10.1148/rg.312105123] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Foreign objects are not infrequently seen at computed tomography (CT) of the abdomen and pelvis and may pose a diagnostic challenge to the radiologist, who must recognize the object, characterize its nature and location, and determine its clinical significance. Most foreign objects are incidentally detected at CT, but they may mimic a wide range of pathologic conditions. Some foreign objects (eg, an object that has been swallowed either intentionally or unintentionally) are the cause of the patient's signs and symptoms and require prompt medical attention. Other objects, such as a sponge or surgical instrument that has been retained postoperatively, may have medicolegal consequences. Furthermore, certain objects, such as intentionally concealed drug packets, may go undetected unless a high degree of suspicion exists and appropriate window settings are used to review the study. The radiologist should be familiar with the wide range of foreign objects that may be encountered at abdominopelvic CT, be able to recognize them promptly, and understand their implications for patient treatment.
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Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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Video-assisted Thoracoscopic Surgery (VATS) drainage of salmonella enteritidis empyema and needle-localization for retrieval of a dropped gallstone. Surg Laparosc Endosc Percutan Tech 2010; 20:265-8. [PMID: 20729699 DOI: 10.1097/sle.0b013e3181e1392e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Spillage of gallstones into the peritoneal cavity (dropped gallstones) is more common in laparoscopic compared with open cholecystectomy. Subsequent infectious complications are often delayed, occurring in 0.1% to 2.9% of cases. We present the first reported case of Salmonella enterica subphrenic abscess and empyema complicating dropped gallstones, treated with video-assisted thoracoscopic surgery (VATS), and surgical retrieval. CASE REPORT A 67-year-old male with symptomatic cholelithiasis underwent an uncomplicated laparoscopic cholecystectomy. Four years later, he presented with a mass in his right flank, and an abdominal computed tomography (CT) revealed a right flank intramuscular abscess containing gallstones. The abscess was drained surgically with removal of gallstones. He was readmitted 15 months later with right upper quadrant pain, fever, and dyspnea. Chest and abdominal computer tomography (CT) showed a right pleural effusion and a right subphrenic abscess containing a dropped gallstone. The gallstone was localized with a needle using CT guidance. He subsequently underwent a right VATS for decortication. A separate flank incision was made at the site of the needle to drain the subphrenic abscess and retrieve the gallstone. Cultures from his empyema grew S enteritidis. The patient made an uneventful recovery. DISCUSSION During laparoscopic cholecystectomy, efforts should be made to retrieve dropped gallstones as they can cause abscess and empyema, which might necessitate furthermore surgical intervention. The use of VATS has been established as a safe and effective alternative to thoracotomy, including the treatment of empyema. Needle-localization resulted in a successful retrieval of the gallstone in our patient. Culture of the abscess is important, as unusual organisms such as Salmonella could be present. S. enteritidis has not been implicated as a cause of cholecystitis and is rarely associated with abdominal abscesses. We postulate that the organism reached the gallbladder through the bile or bloodstream after gastrointestinal colonization and that its persistence in the gallbladder may have been facilitated by gallstones.
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Maempel J, Darmanin G, Paice A, Uzkalnis A. An unusual "hernia": losing a stone is not always a good thing! BMJ Case Rep 2009; 2009:bcr12.2008.1321. [PMID: 21686366 DOI: 10.1136/bcr.12.2008.1321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 42-year-old woman presented to the surgical outpatient department with what appeared to be a strangulated recurrent paraumbilical hernia. She was taken to theatre, where exploration revealed an unexpected diagnosis: an abdominal wall abscess that had formed around what appeared to be a gallstone dropped at the umbilical port site of a laparoscopic cholecystectomy performed 10 years previously. The abscess was incised and drained and a connection with the abdominal cavity excluded. The patient made a full recovery. Complications relating to spilled gallstones are rare, but can present in a variety of ways and sometimes many years after the original surgery. They should always be considered in a patient with a history of cholecystectomy presenting with an abdominal wall mass. There is no clear evidence of the best imaging modalities to be used for investigation. Methods for reducing the risk of such complications and the principles of different treatments are discussed.
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Affiliation(s)
- Julian Maempel
- Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, UK
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EGCG reducing the susceptibility to cholesterol gallstone formation through the regulation of inflammation. Biomed Pharmacother 2008; 62:677-83. [PMID: 18374538 DOI: 10.1016/j.biopha.2007.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 12/18/2007] [Indexed: 11/20/2022] Open
Abstract
In order to investigate whether (-)-Epigallocatechin-3-gallate (EGCG) can reduce the susceptibility to cholesterol gallstone formation in vivo, cholesterol gallstones mouse model was established with lithogenic diet. Compared with the Model group, the administration of EGCG (40 mg kg(-1)d(-1) and 80 mg kg(-1)d(-1), i.g., respectively) significantly reduced the gallstone formation rates and the serum lipid levels, also maintained the body weight at a relatively low level. Results of the microarray profiling assay showed the anti-inflammation effect of EGCG underlying affecting the hepatic metabolic pathway of cholesterol. Additionally, the expression of nuclear factor-kappaB (NF-kappaB) was down-regulated and the expression of peroxisome proliferator activated receptor gamma (PPARgamma) was up-regulated after the treatment of EGCG. Also, the expression of CYP7A1 was up-regulated after the treatment of EGCG. In conclusion, the findings of this study implied that EGCG can effectively reduce the susceptibility to cholesterol gallstone formation through the regulation of inflammation.
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