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Tun KM, Naga Y, Aponte-pieras J, Bhaya B. Intrapulmonary Gallstones and Pleuro-Biliary Fistula Formation Due to Complication From Prior Cholecystectomy: A Case Report and Literature Review. Cureus 2022; 14:e25836. [PMID: 35836468 PMCID: PMC9273197 DOI: 10.7759/cureus.25836] [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] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
Intrapulmonary gallstones and the formation of pleuro-biliary fistula is a rare complication of laparoscopic cholecystectomy. The stones are most commonly found in the right lower lobe of the lungs. The symptoms tend to be insidious in nature and can manifest as hemoptysis, irritating cough, and cholelithoptysis years after the procedure. The stones can be removed through lobectomy or may also be treated non-invasively with antibiotics only. Here, we describe a case of a patient who developed hemoptysis and was found to have intrapulmonary gallstones from laparoscopic cholecystectomy and subsequent fistula formation.
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Tokuda A, Maehira H, Iida H, Mori H, Nitta N, Maekawa T, Takebayashi K, Kaida S, Miyake T, Kuroda R, Yamamoto H, Tani M. Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report. Surg Case Rep 2022; 8:62. [PMID: 35389108 PMCID: PMC8991281 DOI: 10.1186/s40792-022-01419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC. CASE PRESENTATION We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up. CONCLUSIONS We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.
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Affiliation(s)
- Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Nobuhito Nitta
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Ryo Kuroda
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Haruka Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
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Guruvaiah N, Ponnatapura J. Bronchobiliary fistula: a rare postoperative complication of spilled gallstones from laparoscopic cholecystectomy. BMJ Case Rep 2021; 14:14/7/e243198. [PMID: 34315741 PMCID: PMC8317083 DOI: 10.1136/bcr-2021-243198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bronchobiliary fistula (BBF) is defined as the abnormal connection between the biliary system and the bronchial tree, which presents clinically as an irritant cough with bilioptysis. Many conditions can lead to its development. We present a case of an acquired BBF in a 61-year-old man with a significant history of spilled gallstones from a prior laparoscopic cholecystectomy and subsequent presentation of intermittent right upper quadrant pain and recurrent pneumonia. Imaging studies revealed a liver and subdiaphragmatic abscess with right middle lobe pneumonia and a BBF traversing the right hemidiaphragm. The patient was surgically managed by takedown of fistula with drainage of the abscess and removal of spilled gallstone, followed by a resection of the right middle lobe. While previous studies indicate spilled gallstones are benign, this case demonstrates its potential for serious complications. Therefore, early diagnosis and proper management is essential as BBF has a high morbidity and mortality rate.
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Affiliation(s)
| | - Janardhana Ponnatapura
- Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Tchercansky AN, Fernandez Alberti J, Panzardi N, Auvieux R, Buero A. Thoracic empyema after gallstone spillage in times of Covid. Int J Surg Case Rep 2020; 76:221-226. [PMID: 33042769 PMCID: PMC7531285 DOI: 10.1016/j.ijscr.2020.09.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 11/19/2022] Open
Abstract
Thoracic complications after spilled gallstones are rare. Thoracic consequences should be considered in every patient with thoracic symptoms and history of cholecystectomy. Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients. Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment.
Introduction Laparoscopic cholecystectomy has become the gold standard for gallbladder disease. Although gallbladder perforation and spilled gallstones during surgery are common complications, thoracic consequences are rare. Presentation of case We describe a case of a pleural empyema developed in an immunosuppressed patient five months after laparoscopic cholecystectomy, as a result of spilled gallstones. Decortication via video assisted thoracoscopy resulted in retrieval of stone remnants, biliary sludge and diagnosis of a diaphragmatic defect. Discussion Iatrogenic perforation of the gallbladder is the most common complication after laparoscopic cholecystectomy. Despite this, thoracic consequences derived from spilled gallstones are rare, but they represent significant morbidity. Conclusion Thoracic complications after spilled gallstones are rare. Documentation of iatrogenic perforation of the gallbladder and a high index of suspicious are fundamental to speed diagnosis and treatment.
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Affiliation(s)
| | | | - Nicolas Panzardi
- General Surgery Department, British Hospital of Buenos Aires, Argentina
| | - Rodolfo Auvieux
- Thoracic Surgery Department, British Hospital of Buenos Aires, Argentina
| | - Agustin Buero
- Thoracic Surgery Department, British Hospital of Buenos Aires, Argentina
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5
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Sánchez-Moreno L, Ballesteros MA, Peña-Gómez E, Pérez Martín I. Hemoptysis as a Manifestation of Gallstone Ectopia in the Lungs. Arch Bronconeumol 2019; 55:498-499. [PMID: 30971366 DOI: 10.1016/j.arbres.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/01/2019] [Accepted: 01/14/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Laura Sánchez-Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - María A Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Cantabria, España.
| | - Elena Peña-Gómez
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Inés Pérez Martín
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Cantabria, España
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6
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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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Abstract
An octogenarian presented to her primary care physician with hemoptysis and a disabling chronic cough that developed several months after a complicated partial cholecystectomy. During investigation, a biopsy sample showed a right lower lobe inflammatory mass containing bile pigment and abundant neutrophils. Thoracotomy performed approximately 18 months after symptom onset confirmed a right lower lobe lung abscess together with a large gallstone embedded at its center and a healed defect in the right hemidiaphragm. A wedge excision of this mass was performed. The patient made an excellent uncomplicated recovery from this rare complication of a gallbladder operation.
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Hashimoto M, Sasaki K, Matsuda M, Watanabe G. Hepatectomy for liver abscess caused by stones spilled during laparoscopic cholecystectomy. Asian J Endosc Surg 2014; 7:60-2. [PMID: 24450346 DOI: 10.1111/ases.12061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/17/2013] [Accepted: 09/01/2013] [Indexed: 11/28/2022]
Abstract
An abdominal abscess caused by spilled stones is a serious complication of laparoscopic cholecystectomy that requires drainage or reoperation to remove the scattered stones. Herein, we report the case of a 50-year-old woman, who was on dialysis for renal failure. She underwent major hepatectomy for a liver abscess caused by stones spilled during laparoscopic cholecystectomy.
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Affiliation(s)
- Masaji Hashimoto
- Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute of Medical Research, Tokyo, Japan
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9
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Saito Y, Shibata S, Akayama K, Takahashi T. Thoracic empyema due to migrated endoclips after laparoscopic cholecystectomy. Asian J Endosc Surg 2012; 5:89-92. [PMID: 22776371 DOI: 10.1111/j.1758-5910.2011.00123.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe the case of a patient who developed right thoracic empyema 1 year after laparoscopic cholecystectomy. The patient experienced right chest pain and swelling; radiography and CT showed an intrathoracic abscess penetrating the extrathoracic space and the presence of metal clips over the diaphragm. After drainage of the subcutaneous abscess, fluid accumulation decreased; bacterial examination showed no positive findings. Another year later, the patient's condition relapsed. We thought that the empyema may have been caused by endoclips that had migrated. We performed thoracoplasty and retrieved three endoclips from the intrathoracic empyema cavity. The patient showed good recovery after the operation.
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Affiliation(s)
- Y Saito
- Division of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan.
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10
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Unusual enhancing foci. Am J Med 2012; 125:31-3. [PMID: 22055249 DOI: 10.1016/j.amjmed.2011.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 11/20/2022]
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11
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Bergeron E, Beaulieu C, Passerini L, Ratte S. Dropped Gallstones Causing Transdiaphragmatic Migration and Thoracic Empyema. Ann Thorac Surg 2007; 84:1760-2. [DOI: 10.1016/j.athoracsur.2007.06.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 05/29/2007] [Accepted: 06/13/2007] [Indexed: 12/22/2022]
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12
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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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13
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Bas G, Eryilmaz R, Akcakaya A, Daldal E, Alimoglu O, Okan I, Sahin M. The Effect of the Degree of Histologic Inflammation on Gallbladder Perforation During Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2005; 15:130-4. [PMID: 15898902 DOI: 10.1089/lap.2005.15.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Laparoscopic cholecystectomy (LC) is the gold standard operation for the treatment of symptomatic gallstones. Intraoperative gallbladder perforation is a common complication encountered during the surgery. The purpose of this study was to identify the effects of inflammation on gallbladder perforation during LC. METHODS Between July 1997 and March 2003, 509 patients underwent LC for symptomatic gallstone disease at the Department of Surgery at Vakif Gureba Training Hospital. Data were collected retrospectively. Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, experience of the surgeon, omental and other organ adhesions to the gallbladder, and the findings of inflammation on the resected gallbladder. RESULTS Intraoperative gallbladder perforation occurred in 85 patients (16.6%). Although no differences were found between the perforated and nonperforated groups regarding age, gender, and chronic inflammation on the resected gallbladder, there were significant differences in terms of acute inflammation, anatomical difficulty, experience of the surgeon, and omental and organ adhesions. CONCLUSION Acute inflammation, degree of anatomic difficulty, the experience of the surgeon, and omental or other organ adhesions were associated with gallbladder perforation during LC.
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Affiliation(s)
- Gurhan Bas
- Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey.
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14
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Houghton SG, Crestanello JA, Nguyen AQT, Deschamps C. Lung Abscess Due to Retained Gallstones With an Adenocarcinoma. Ann Thorac Surg 2005; 79:e26-7. [PMID: 15734370 DOI: 10.1016/j.athoracsur.2004.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2004] [Indexed: 11/23/2022]
Abstract
We describe a patient who had a right lower lobe mass containing calcifications consistent with gallstones develop 3(1)/(2) years after laparoscopic cholecystectomy. Thoracotomy revealed a chronic abscess containing pigmented gallstones and an adjacent area of bronchoalveolar adenocarcinoma involving both N1 and N2 lymph nodes.
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Affiliation(s)
- Scott G Houghton
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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15
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Villena Garrido V, Sánchez-Bustos Cobaleda F, Rey Terrón L, Menchén Trujillo B, Campano Cruz I. [Recurrent pneumonia and empyema due to Klebsiella pneumoniae as a complication of laparoscopic cholecystectomy]. Arch Bronconeumol 2001; 37:265-6. [PMID: 11412520 DOI: 10.1016/s0300-2896(01)75065-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a patient with pneumonia and empyema secondary to an abdominal abscess due to Klebsiella pneumoniae from stones released into the abdominal cavity during laparoscopic cholecystectomy.
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Ramnarine IR, Mulpur AK, McMahon MJ, Thorpe JA. Pleuro-biliary fistula from a ruptured choledochal cyst. Eur J Cardiothorac Surg 2001; 19:216-8. [PMID: 11167116 DOI: 10.1016/s1010-7940(00)00632-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We present a case of rupture of an intrahepatic choledochal cyst through the diaphragm resulting in a pleuro-biliary fistula and a right pleural empyema which was surgically treated. Hepatobiliary complications resulting in biliary empyema of the pleura are discussed.
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Affiliation(s)
- I R Ramnarine
- Department of Thoracic surgery, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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17
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Chan SY, Osborne AW, Purkiss SF. Cholelithoptysis: an unusual complication following laparoscopic cholecystectomy. Dig Surg 2000; 15:707-8. [PMID: 9845642 DOI: 10.1159/000018663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A 75-year old lady underwent a routine laparoscopic cholecystectomy during which stones were spilled into the peritoneal cavity. Despite peritoneal lavage the patient developed chronic right upper quadrant discomfort and a pleural effusion over several months. Following the production of a pigmented bilirubin stone in her sputum the patient's symptoms resolved. Cholelithoptysis is a rare complication of laparoscopic cholecystectomy, the diagnosis should be considered in patients with prolonged chest symptoms after surgery.
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Affiliation(s)
- S Y Chan
- Academic Department of Surgery, Royal London Hospital, London, UK
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18
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Preciado A, Matthews BD, Scarborough TK, Marti JL, Reardon PR, Weinstein GS, Bennett M. Transdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 1999; 9:517-21. [PMID: 10632515 DOI: 10.1089/lap.1999.9.517] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.
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Affiliation(s)
- A Preciado
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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19
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Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH. Iatrogenic Gallbladder Perforation during Laparoscopic Cholecystectomy: Etiology and Sequelae. Am Surg 1999. [DOI: 10.1177/000313489906501010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Iatrogenic perforation of the gallbladder (PGB) during laparoscopic cholecystectomy (LC) leads to spillage of bile and gallstones into the peritoneal cavity, which can result in serious postoperative infection. The objective of this study is to prospectively evaluate with long-term follow-up the risk factors, mechanisms, and complications associated with PGB in patients undergoing LC. Data from 1412 patients undergoing LC were collected prospectively between 1989 and 1995. Patients with and without iatrogenic gallbladder perforation were compared. Long-term follow-up was obtained using mailed questionnaires and telephone interviews, when needed. Of the 1412 patients, 512 (36%) sustained a PGB. Male sex, weight, gallbladder inflammation, thickening of the gallbladder, presence of adhesions, and a difficult hilar dissection were all associated with an increased incidence of PGB. The most common mechanisms of PGB were laceration due to grasper traction (55%) and electrocautery dissection (40%). Both the operating time and length of hospital stay were significantly longer in the PGB group. No difference was observed in the rate of wound infections between PGB and non-PGB patients (1.6% versus 1.8%). Only one patient (with an inflamed and perforated gallbladder) developed an early postoperative intra-abdominal abscess. Long-term follow-up averaging 48 months was achieved with a response rate of 44 per cent. No late intra-abdominal abscesses or complications attributable to retained gallstones were discovered.
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Affiliation(s)
- Thomas T. Hui
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dan I. Giurgiu
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sumito Takagi
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Atsushi Iida
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Affiliation(s)
- J Laredo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Torres OJM, Valadão JA, Silva AJR, Macau RP, Cintra JCA, Dietz UA, Nassif PAN. EFEITO DE CÁLCULOS BILIARES HUMANOS NA CAVIDADE PERITONEAL DE RATOS. Acta Cir Bras 1998. [DOI: 10.1590/s0102-86501998000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo tem por objetivo analisar experimentalmente as características macroscópicas e microscópicas de cálculos biliares humanos na cavidade peritoneal de ratos. Foram utilizados 32 ratos Wistar, machos, pesando entre 205 e 268 g. Estes animais foram distribuídos em dois grupos e o procedimento cirúrgico foi realizado em cada grupo: no grupo A (n =16), os animais foram submetidos a manipulação intestinal; no grupo B (n=16), cálculos biliares humanos foram colocados na cavidade peritoneal. Os ratos foram avaliados no 21º e 42º dias do período pós-operatório. Os resultados mostraram que a simples manipulação causou aderências nos animais (n=10). As aderências foram notadas em 11 cálculos no grupo B. Histologicamente não houve fibrose intensa em torno do cálculo, principalmente no 42º dia do período pós-operatório. Não foram observados macro ou micro abscessos e não houve evidências de fluído livre intra-peritoneal. Este estudo demonstra que apesar da baixa incidência de complicações, todas as tentativas devem ser feitas para recuperar cálculos perdidos durante colecistectomia.
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22
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Horton M, Florence MG. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am J Surg 1998; 175:375-9. [PMID: 9600281 DOI: 10.1016/s0002-9610(98)00048-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. METHODS Between 1993 and 1995, 1,130 laparoscopic cholecystectomies were performed at two major metropolitan medical centers. Of these patients, we know of 3 (0.3%) who subsequently developed abscesses as a consequence of dropped stones during the laparoscopic cholecystectomy. One additional patient who underwent prior laparoscopic cholecystectomy at another institution developed late infection as well. RESULTS All 4 patients developed late purulent abscesses that ultimately required open surgical drainage, and 1 patient developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. Significant costs were involved in the diagnosis, management, and duration of therapy for these problems. CONCLUSIONS This experience closely resembles that of other centers and points out the existence of a late postoperative complication following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies for avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of laparoscopic cholecystectomy with or without placement of a drain in the subhepatic space does not prevent this complication.
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Affiliation(s)
- M Horton
- Department of Surgery, Swedish Medical Center, Seattle, Washington, USA
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Abstract
We describe a patient who suffered right pleuritic chest pain and an exudative pleural effusion, leading to empyema formation. Thoracotomy revealed this to be due to a subphrenic abscess around spilled gall stones.
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Affiliation(s)
- C J Kelty
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
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Abstract
Two months after laparoscopic cholecystectomy, a 54-year-old man presented for medical care with cholelithoptysis (the coughing up of gallstones). This rare complication was managed without a further operation. Possible mechanisms and preventive measures are discussed.
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