The last place you would expect to find a gallstone

Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report

One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient's decision to refuse abscess's surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

Consequences of spilt gallstones during laparoscopic cholecystectomy

To document the incidence of spilt gallstones during laparoscopic cholecystectomy, the cause and consequences of such spillage. The study included 150 consecutive laparoscopic cholecystectomies performed between October 2007 and November 2008. Data was collected in a prospective manner in accordance to proforma. Follow up were performed at the end of 1 week, 1 month, 6 months and 1 year. The spillage of gall stones during surgery occurred in 19.04 % of the cases. Majority of the spillage occurred due to perforation of the gall bladder during dissection, followed by application of toothed grasper. Although all visible spilt stones were retrieved during surgery, complication rate of 0.66 % was observed. The incidence and complications secondary to the spillage of gall stones during standard laparoscopic cholecystectomy is low but avoidable. Various complications can occur, over a large period of time. Thus it is advisable to retrieve as many gallstones as possible short of converting to a laparotomy Dasari and Loan (JSLS 13(1):73-76, 2009), Daradkeh and Suwan (World J Surg 22:75-77, 1998).