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Danhel L, Fritz A, Havranek L, Kratzer T, Punkenhofer P, Punzengruber A, Rezaie D, Tatalovic S, Wurm M, Függer R, Biebl M, Kirchweger P. Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication-case report and review of the literature. Front Surg 2024; 11:1375502. [PMID: 38655209 PMCID: PMC11035747 DOI: 10.3389/fsurg.2024.1375502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC. Methods Case report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022. Case Report An 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation. Conclusion Intraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
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Affiliation(s)
- L. Danhel
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Fritz
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - L. Havranek
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - T. Kratzer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - P. Punkenhofer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Punzengruber
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - D. Rezaie
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - S. Tatalovic
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - M. Wurm
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - R. Függer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - M. Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - P. Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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2
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Dahlqvist G, Marique L. Unusual history of 'stitch'. Gut 2024:gutjnl-2023-331869. [PMID: 38378249 DOI: 10.1136/gutjnl-2023-331869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Geraldine Dahlqvist
- Hepatogastroenterology and Liver Transplantation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Lancelot Marique
- Abdominal Surgery and Liver Transplantation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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Erfan MA, Thabet EAM, Rageh MA, Mohy SM, El Wardany I. The effect of triclosan-coated sutures on the incidence of surgical site infection in laparoscopic sleeve gastrectomy, laparoscopic appendicectomy or laparoscopic cholecystectomy: A multi-centre, double-blind, randomized, intra-individual study. Int Wound J 2024; 21:e14387. [PMID: 37705324 PMCID: PMC10784617 DOI: 10.1111/iwj.14387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
Surgical site infection (SSI) is a common cause of post-operative morbidity. According to the latest report announced by CDC, the SSI accounts for 20% of healthcare-associated infection with a high risk of mortality up to twofold to 11-fold increase with high economic burden for the prolonged hospital stay. Port site infection (PSI) is a subgroup of SSI occurring at the ports of laparoscopy. We tried to determine the efficacy of polyglactin 910 suture coated with triclosan in lowering the rate of PSI in some of the clean-contaminated wound surgeries. This study included 480 individuals eligible for laparoscopic cholecystectomy, appendicectomy or sleeve operations. Polyglactin 910 sutures coated with triclosan were used in one port site incision while polyglactin 910 sutures were used in the other port sites incisions. In patients who underwent laparoscopic cholecystectomy and appendicectomy, the incidence of PSI was significantly lower in the triclosan-coated sutures. In sleeve gastrectomy patients, although a lower number of triclosan-coated sutures developed PSI, there was no statistically significant difference between triclosan and non-triclosan-coated sutures. This study showed that using sutures coated with antiseptics like triclosan has clinical benefits to prevent SSIs in most of the laparoscopic surgeries.
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Affiliation(s)
- Moatasem A. Erfan
- Department of General SurgeryFaculty of Medicine, Misr University for Science and Technology (MUST)GizaEgypt
| | - El Ashraf M. Thabet
- Department of General SurgeryFaculty of Medicine, Fayoum UniversityFayoumEgypt
| | - Mahmoud A. Rageh
- Department of DermatologyFaculty of Medicine, Al‐Azhar UniversityCairoEgypt
| | - Sara M. Mohy
- Department of DermatologyFaculty of Medicine, Misr University for Science and Technology (MUST)GizaEgypt
| | - Ibrahim El Wardany
- Department of General SurgeryFaculty of Medicine, Misr University for Science and Technology (MUST)GizaEgypt
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Orschel C, Gammel L, Bray SA, Burns B. Incarcerated Inguinal Hernia Containing a Gallstone Found Decades After a Laparoscopic Cholecystectomy. Cureus 2023; 15:e44518. [PMID: 37790052 PMCID: PMC10544610 DOI: 10.7759/cureus.44518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Iatrogenic gallbladder perforation and subsequent gallstone spillage is a common problem in laparoscopic cholecystectomy. While most commonly asymptomatic, complications due to spilled gallstones have been reported. In this case study, we report the case of a 96-year-old female with a history of laparoscopic cholecystectomy at an unknown time who presented with an incarcerated inguinal hernia and small bowel obstruction. Imaging revealed an extraluminal radiopaque foreign body located near the hernia sac. At the time of the repair, she was found to have a single gallstone located within the hernia sac, confirmed by pathology. The hernia was repaired using Lichtenstein, and her bowel obstruction was resolved postoperatively. Although gallstone spillage from iatrogenic gallbladder perforation during laparoscopic cholecystectomy is a relatively common problem, it is rarely symptomatic and may be associated with infection, abscess, and fistula formation. A rarer complication includes the formation of hernias containing gallstones, documented in fewer than 10 cases in the literature. This case demonstrates a rare consequence of leaving behind spilled gallstones following gallbladder perforation during laparoscopic cholecystectomy. It emphasizes the importance of preventing iatrogenic gallbladder perforation and retrieving any spilled gallstones during the procedure to minimize associated complications.
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Affiliation(s)
- Catlin Orschel
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Lauren Gammel
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Sheree A Bray
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
| | - Bracken Burns
- Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, USA
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Malhotra S, Lara-Reyna J, Harvey EJ, Yu AT. Delayed Post-cholecystectomy Gallbladder Fossa Abscess Due to Citrobacter freundii. Cureus 2023; 15:e37169. [PMID: 37153296 PMCID: PMC10162692 DOI: 10.7759/cureus.37169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
While laparoscopic cholecystectomy has become the treatment of choice for cholecystitis, complications such as abscess development can result even years after the intervention. We present a case of a patient with a remote history of laparoscopic cholecystectomy now diagnosed with gallbladder fossa abscess infected with Citrobacter freundii, a low-virulence pathogen typically seen in iatrogenic urinary tract infections. Subsequent conjoint percutaneous drainage and long-term antibiotics resulted in both clinical and radiological improvement for the patient. Therefore, in the absence of recent events or risk factors for developing an abdominal wall abscess, a previous remote history of surgical intervention needs to be considered for the possible etiology, especially those with low incidences and long latency periods such as Citrobacter.
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Syed F, Quah GS, Di Re A. Port site intramuscular abscess from retained gallstone post laparoscopic cholecystectomy - an unusual complication. J Surg Case Rep 2023; 2023:rjac611. [PMID: 36628063 PMCID: PMC9825240 DOI: 10.1093/jscr/rjac611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
Perforation of the gallbladder and the spillage of gallstones can be a cause of ongoing morbidity and mortality in patients post cholecystectomy. We report on an unusual case of a 58-year-old male who developed a right upper quadrant lump 8 years after laparoscopic cholecystectomy which was eventually determined to be an abscess from a retained gallstone that had become embedded in the musculature of his abdominal wall. We have also discussed some of the considerations taken in the surgical management of this case.
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Affiliation(s)
- Faisal Syed
- Correspondence address. Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia. Tel: +61 420 882 522; E-mail:
| | - Gaik Si Quah
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
| | - Angelina Di Re
- Department of Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia
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Almslam MS, Alshehri AI, Alshehri AA, Peedikayil MC, Alkahtani KM. Intra-Abdominal Spilled Gallstones Mimicking Malignancy: A Case Report and a Literature Review. Cureus 2022; 14:e32376. [DOI: 10.7759/cureus.32376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
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Bofill AM, Mahmoud T, Takahashi EA, Chandrasekhara V. Endoscopic approach for management of dropped gallstones using percutaneous cholangioscopy. VideoGIE 2022; 8:23-26. [PMID: 36644251 PMCID: PMC9832278 DOI: 10.1016/j.vgie.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Video 1Endoscopic approach for management of dropped gallstones using percutaneous cholangioscopy.
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Affiliation(s)
- Aliana M Bofill
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Weeraddana P, Weerasooriya N, Thomas T, Fiorito J. Dropped Gallstone Mimicking Retroperitoneal Tumor 5 Years After Laparoscopic Cholecystectomy Posing a Diagnostic Challenge. Cureus 2022; 14:e31284. [DOI: 10.7759/cureus.31284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
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Gavriilidis P, Catena F, de’Angelis G, de’Angelis N. Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review. World J Emerg Surg 2022; 17:57. [PMID: 36324150 PMCID: PMC9632095 DOI: 10.1186/s13017-022-00456-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. METHODS Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. RESULTS Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. CONCLUSIONS Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
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Affiliation(s)
- Paschalis Gavriilidis
- grid.412944.e0000 0004 0474 4488Department of Surgery, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ Cornwall UK
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gianluigi de’Angelis
- grid.10383.390000 0004 1758 0937Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Nicola de’Angelis
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, Clichy, France
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Al-janabi MH, Aslan RG, Hasan AM, Doarah M, Daoud R, Wassouf A, Houreih MA. Dropped gallstones mimicking intraabdominal implants or tumor: A report of two cases. Ann Med Surg (Lond) 2022; 81:104557. [PMID: 36147142 PMCID: PMC9486857 DOI: 10.1016/j.amsu.2022.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Dropped gallstones are an uncommon complication of laparoscopic cholecystectomy (LC). We report two cases of dropped gallstones that were unexpectedly found during surgery. Clinicians should check the history of LC in patients presenting with a mass-forming lesion in the peritoneal cavity.
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12
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Nagata K, Fujikawa T, Oka S, Osaki T. A Case of Intractable Lung Abscess Following Dropped Gallstone-Induced Subphrenic Abscess: A Rare Postoperative Complication Caused by Dropped Gallstone During Laparoscopic Cholecystectomy. Cureus 2022; 14:e27491. [PMID: 36060363 PMCID: PMC9425714 DOI: 10.7759/cureus.27491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/29/2022] Open
Abstract
Dropped gallstones into the abdominal cavity due to perforation of the gallbladder occasionally occur during laparoscopic cholecystectomy. Abscess formation caused by residual gallstones is one of the late postoperative complications after laparoscopic cholecystectomy. Most of them are intra-abdominal abscesses; however formation of intra-thoracic abscesses, in particular, lung abscess, is less described, and surgery for an intra-thoracic abscess is rarely performed. We describe a case of intractable lung abscess following dropped gallstone-induced subphrenic abscess caused by a residual gallstone after laparoscopic cholecystectomy.
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Abstract
Cholecystectomy is one of the most common surgeries performed in the United States. Although complications are uncommon, the high incidence of this surgery means that a radiologist will likely encounter these complications in practice. Complications may arise in the immediate postoperative period or can be delayed for weeks, months, or years after surgery. Vague and nonspecific symptoms make clinical diagnosis challenging. As a result, multimodality imaging is important in postoperative evaluation. US and multidetector CT are the usual first-line imaging modalities. Hepatobiliary scintigraphy, SPECT/CT, and MRI with conventional or gadoxetate hepatobiliary contrast material are important and complementary modalities that are used for workup. The authors begin with a brief discussion of surgical technique and expected postoperative findings and then describe complications organized into four groups: (a) biliary complications, (b) stone-related complications, (c) iatrogenic complications, and (d) gallbladder complications. Biliary complications include bile leaks and bilomas, acute biliary obstruction, and biliary stricture. Stone-related complications include retained and recurrent stones and spillage of stones into the peritoneum. Iatrogenic complications include hemorrhage, vasculobiliary injury, arterial pseudoaneurysms, duodenal injury, and migration of clips. Gallbladder complications include recurrent cholecystitis after subtotal reconstituting cholecystectomy and unexpected gallbladder cancer. An invited commentary by Mullens and Ibrahim is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Neel Patel
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Kyle K Jensen
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Elena Korngold
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Bryan R Foster
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
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Kumar K, Haas CJ. Dropped Gallstone Presenting as Recurrent Abdominal Wall Abscess. Radiol Case Rep 2022; 17:2001-2005. [PMID: 35432673 PMCID: PMC9010691 DOI: 10.1016/j.radcr.2022.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/22/2022] Open
Abstract
Dropped gallstones are a known complication of laparoscopic cholecystectomy. Rarely, dropped stones may be embedded within the potential intraperitoneal spaces or abdominal wall, mimicking metastatic implants, tuberculosis, peritoneal loose body, actinomyces, and primary tumors, which when coupled with the fact that most bile stones are radiolucent, leads to diagnostic challenges. Here, we report a case of abdominal wall abscess due to a dropped stone that presented over 15 years after laparoscopic cholecystectomy. An 86-year-old male with laparoscopic cholecystectomy for management of acute cholecystitis complicated by post-cholecystectomy choledocholithiasis over 15 years back presented to the emergency department with intermittent, asymmetric abdominal “bulging” and a reported 16-pound weight loss of 3 months duration. He remained hemodynamically stable and physical examination demonstrated approximately 9 cm × 7 cm, nontender and slightly fluctuant mass appreciable on the right lateral abdominal wall extending to the right flank. Laboratory revealed leukocytosis and elevated lactic acid. Abdominal ultrasound and abdominal computed tomography demonstrated a 10.6 × 7 × 16 cm cystic mass with echogenic debris adjacent to the anterior segment of the right hepatic lobe. The patient presented multiple times with re-accumulation. A drain was subsequently placed and antibiotic therapy initiated with subsequent resolution. Follow-up magnetic resonance imaging revealed a punctate calcification within the abscess pocket. Retained stones should be considered in the differentials of patients presenting with abdominal discomfort and abdominal “masses.” The clinical suspicion must remain high secondary to the potential temporally prolonged presentation, indolent nature of inflammation, and unusual sites of physical manifestations.
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Salati SA, Alfehaid M, Alsuwaydani S, AlSulaim L. Spilled gallstones after laparoscopic cholecystectomy: a systematic review. Pol Przegl Chir 2022; 95:1-20. [PMID: 36805307 DOI: 10.5604/01.3001.0015.8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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McNamee M, Chambers JG. Spilled Gallstones Presenting as Left Lower Quadant Abdominal Pain Consistent With Diverticulitis. Am Surg 2022; 88:1530-1531. [PMID: 35282711 DOI: 10.1177/00031348221080422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that the incidence of spilled gallstones during laparoscopic cholecystectomy can be from 6-40%. Treatment of these sequelae are often reactive to symptoms produced from the presence of the spilled stones. Herein is presented a case of a 57 year old male with a history of left lower quadrant abdominal pain that had been present for several years and was thought to be due to diverticulitis. On diagnostic laparoscopy he was found to have multiple stones causing an inflammatory response in his left lower quadrant. These stones were removed and the left lower quadrant was washed out. The patient recovered well and had abatement of symptoms at his two months postoperative visit. This case is an example of a spilled gallstones being confused as diverticulitis. Recognition of the spilled stones on diagnostic laparoscopy spared the patient a larger operation and resulted in his symptoms resolving.
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Affiliation(s)
- Molly McNamee
- 471918Northeast Georgia Health System, Braselton, GA, USA
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Perrotti G, O'moore P, Kirton O. Hey, you forgot something! The Management of Symptomatic Retained Gallstones. Surgery in Practice and Science 2022; 8:100052. [DOI: 10.1016/j.sipas.2021.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alzeer ZA, Alghafees MA, Bedah K. Achromobacter xylosoxidans Subdiaphragmatic Collection as a Result of a Dropped Stone During Laparoscopic Cholecystectomy. Cureus 2021; 13:e17881. [PMID: 34660080 PMCID: PMC8502532 DOI: 10.7759/cureus.17881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/05/2022] Open
Abstract
After a cholecystectomy, dropped stones can serve as a nidus for abscess formation. Intrabdominal abscesses tend to cause irritation and inflammation of the peritoneum and are thus rarely asymptomatic. This report discusses a 38-year-old female complaining of a recurrent right upper quadrant pain that led to multiple hospital admissions. Her surgical history was significant for cholecystectomy six years back complicated by a retroperitoneal abscess which was drained twice. A computed tomography (CT) scan was done, and she was diagnosed with a subdiaphragmatic collection as a result of a dropped stone.
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Affiliation(s)
- Zaid A Alzeer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammad A Alghafees
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid Bedah
- Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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20
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Abstract
Percutaneous biliary and gallbladder drainage is routinely performed by interventional radiology. These pathologies and techniques are well described in the literature and in this issue. The purpose of this review is to focus on the recognition and management of complications. Percutaneous biliary drains can have a variety of complications which can range from minor skin issues to more serious and complex bleeding issues. Advancements in imaging and techniques improve the safety profile of percutaneous biliary and gallbladder interventions.
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Affiliation(s)
- Heather Molina
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Maye M Chan
- Division of Vascular and Interventional Radiology, Department of Radiology, M Health Fairview University of Minnesota, Minneapolis, Minnesota
| | - Robert J Lewandowski
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Drahman A, Arulpragasam K, Leibenson L, Sardelic F. A Case of Gallstones Causing Pelvic Pain. Case Rep Surg 2021; 2021:5553994. [PMID: 34336348 DOI: 10.1155/2021/5553994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Assessing abdominal pain, particularly in women of reproductive age, requires thorough history taking, clinical examination, and investigations to obtain an accurate diagnosis. Both surgical and gynecological causes need to be considered, particularly previous relevant surgical history. Presentation of case. We report a case of pelvic pain secondary to multiple gallstones found within the pelvic cavity postlaparoscopic cholecystectomy. Thorough investigations have been conducted without any obvious cause found. The pain was debilitating and largely affecting the patient's quality of life. Therefore, decision to perform diagnostic laparoscopy and gallstones was found all over pelvic cavity and retrieved. Her pain resolved post operatively. Conclusions Gallbladder perforation and stone spillage are the most common complications of laparoscopic cholecystectomy that arise during the removal and dissection of gallbladder and can cause significant morbidity if not managed early, especially retrieval of the stones intraoperatively. Therefore, patient with history of previous cholecystectomy with stone spillage presenting with undifferentiated abdominal pain and early diagnostic laparoscopy should be considered.
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Mehmood S, Singh S, Igwe C, Obasi CO, Thomas RL. Gallstone extraction from a back abscess resulting from spilled gallstones during laparoscopic cholecystectomy: a case report. J Surg Case Rep 2021; 2021:rjab293. [PMID: 34316341 PMCID: PMC8302076 DOI: 10.1093/jscr/rjab293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Laparoscopic cholecystectomy is a routinely performed surgery nowadays. However, it is associated with certain complications. Gall bladder perforation during the procedure can result in spilled and lost gallstones. Lost gallstones most commonly cause intra-abdominal infection. However, very rarely, they can be associated with troublesome retroperitoneal abscess formation. We present a case where a lost gallstone caused a retroperitoneal abscess formation and was retrieved from a back abscess in the right paraspinal region.
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Affiliation(s)
- Saqib Mehmood
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Sohail Singh
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Chukwuemeka Igwe
- Internal Medicine, King Mill Hospital, Sutton-in-Ashfield NG17 4JL, UK
| | - Chekwas O Obasi
- General Surgery, Croydon University Hospital, London, CR77YE, UK
| | - Rhys L Thomas
- General Surgery, Croydon University Hospital, London, CR77YE, UK
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Affiliation(s)
- Charelle Manning
- Speciality Registrar in Hepatology, Department of Hepatology, Norfolk and Norwich University Teaching Hospital, Norwich, UK
| | - Hameed Rafiee
- Consultant Radiologist, Department of Radiology, Norfolk and Norwich University Teaching Hospital, Norwich, UK
| | - Bhaskar Kumar
- Consultant Surgeon, Department of Upper gastrointestinal surgery, Norfolk and Norwich University Teaching Hospital, Norwich, UK
| | - Syed Alam
- Consultant Hepatologist, Department of Hepatology, Norfolk and Norwich University Teaching Hospital, Norwich, UK
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Frade S, Carrelha S, Monteiro N, Moniz L, Viegas H. Missed gallstones in the abdominal wall: complication of a laparoscopic cholecystectomy. Pan Afr Med J 2020; 37:381. [PMID: 33796194 PMCID: PMC7992406 DOI: 10.11604/pamj.2020.37.381.27368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022] Open
Abstract
Laparoscopic cholecystectomy, like any invasive procedure, is associated with complications. One of them often ignored despite its frequency, as the results of the low morbidity rate is stone spillage. We present a case of a 38 years male, with obesity; that underwent laparoscopic cholecystectomy for an acute cholecystitis. During surgery, gallbladder perforation occurred with stone spillage. An attempt was made for recovery of all stones. However, one month after surgery, the patient complained of abdominal pain in the upper right quadrant and an abscess of the deep abdominal wall was found caused by a missed gallstone. Although the definitive treatment was not immediate, an attempt at antibiotic therapy was made, unsuccessfully. Afterwards, this patient underwent gallstone extraction and removal of foreign body granuloma with complete resolution of the clinical condition.
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Affiliation(s)
- Sofia Frade
- Department of General Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sofia Carrelha
- Department of General Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Nuno Monteiro
- Department of General Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Luís Moniz
- Department of General Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Helder Viegas
- Department of General Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Quinn E, Capanegro J, Hartigan J. A case report: Delayed gallstone abscess formation 10 years post-cholecystectomy. Int J Surg Case Rep 2020; 77:903-905. [PMID: 33395921 PMCID: PMC7732970 DOI: 10.1016/j.ijscr.2020.11.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Successful removal of gallstones are important to prevent the formation of gallstone abscess and infection. An increase of reports of gallstone abscess formation shows the importance of awareness in the surgical community of the occurrence and proper treatment techniques. Proper treatment techniques include abscess drainage either surgically or non-invasive and if possible laparoscopic repair of gallstone abscess.
Introduction Retained gallstones post-cholecystectomy act as a nidus for abscess formation. It is unusual for intraabdominal abscesses to remain asymptomatic due to its propensity to cause inflammation and irritation to the peritoneum. Presentation of case A 73-year-old female presented with acute onset of right-sided abdominal pain and fever. Her past surgical history was significant for a cholecystectomy in 2010, hysterectomy, and partial nephrectomy. She was diagnosed with an intraabdominal abscess secondary to a retained gallstone post-cholecystectomy. She underwent laparoscopic surgery to drain and remove the abscess. The patient's abdominal pain improved, remains afebrile, and is passing stool regularly. Discussion Gallbladder perforation is common and is dependent on the integrity of the gallbladder and surrounding structures. It is unusual for an intra-abdominal abscess to develop so late following gallstone spillage. This example brings to light the potential long-term sequelae of gallbladder perforation and future complications. Conclusion This case highlights the importance of irrigation of the peritoneal cavity and retrieval any spilled gallstones during surgery in the event of gallbladder perforation.
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Affiliation(s)
- Erina Quinn
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA.
| | - James Capanegro
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
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Jalil T, Adibi A, Mahmoudieh M, Keleidari B. Could preoperative sonographic criteria predict the difficulty of laparoscopic cholecystectomy? J Res Med Sci 2020; 25:57. [PMID: 33088294 PMCID: PMC7554442 DOI: 10.4103/jrms.jrms_345_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/25/2019] [Accepted: 03/09/2020] [Indexed: 11/04/2022]
Abstract
Background: Although laparoscopic cholecystectomy (LC) is the gold standard approach for gallbladder diseases, this sometimes may face difficulties and require conversion to open surgery. The preoperative ultrasonographic study may provide information about the probability of difficult LC, but the data in this term are uncertain. We assessed the value of preoperative ultrasonographic findings for the prediction of LC's difficulty. Materials and Methods: The current prospective clinical trial was conducted on 150 patients who were candidates for LC due to symptomatic gallstone. All of the patients underwent ultrasonography study preoperatively, and then, LC was performed. The surgeon completed a checklist regarding the easy or difficult surgical criteria. Finally, the values of ultrasonographic findings for the prediction of LC difficulty were evaluated. Results: Among the 150 included patients, 80 had easy LC and 70 had difficult LC. Statistically significant differences were found between the two groups of easy and difficult LC regarding gallbladder wall thickness (P = 0.008), stone impaction (P = 0.009), and gallbladder flow (P = 0.04). The area under the curve (standard error [SE]) for the thickness of the gallbladder wall, flow in the gallbladder wall, and stone impaction was 0.598 ± 0.048, 0.543 ± 0.047, and 0.554 ± 0.047, respectively (P < 0.05). The highest specificity was for gallbladder wall flow (100%). Binary logistic regression showed that stone impaction had predictive value for determining difficult LC (odds ratio = 3.10; 95% confidence interval: 1.03–9.30; P = 0.04). Conclusion: Although a significant difference was observed between two groups in terms of impacted stone, flow in the gallbladder wall, and thickness of the gallbladder wall, only stone impaction had predictive value for determining difficult LC.
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Affiliation(s)
- Taghi Jalil
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atoosa Adibi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoudieh
- Department of General Surgery, Minimally Invasive Surgery and Obesity, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Keleidari
- Department of General Surgery, Minimally Invasive Surgery and Obesity, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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28
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Linstroth L, Shaaban A, Wang SS. Imaging of Postoperative Biliary Complications. Curr Radiol Rep 2020; 8. [DOI: 10.1007/s40134-020-00368-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Arbogast M, Nebiker CA. Misleading Diagnostics After a Presumed Recovery of Gallstone Spillage. J Surg Res (Houst) 2020; 3:297-300. [PMID: 36466297 PMCID: PMC9718555 DOI: 10.26502/jsr.10020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- M Arbogast
- Corresponding Author: M Arbogast, Department of Visceral Surgery, Kantonsspital Aarau, Switzerland;
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30
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Marçal A, Pereira RV, Monteiro A, Dias J, Oliveira A, Pinto-de-Sousa J. Right lumbar abscess containing a gallstone-an unexpected late complication of laparoscopic cholecystectomy. J Surg Case Rep 2020; 2020:rjaa248. [PMID: 32760493 PMCID: PMC7394135 DOI: 10.1093/jscr/rjaa248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.
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Affiliation(s)
- André Marçal
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - Ricardo Vaz Pereira
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - Ana Monteiro
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - José Dias
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - António Oliveira
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
| | - João Pinto-de-Sousa
- Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real, Portugal
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31
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van de Graaf FW, Lange MM, Spakman JI, van Grevenstein WMU, Lips D, de Graaf EJR, Menon AG, Lange JF. Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery. JAMA Surg 2020; 154:381-389. [PMID: 30673072 DOI: 10.1001/jamasurg.2018.5246] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Despite ongoing advances in the field of colorectal surgery, the quality of surgical treatment is still variable. As an intrinsic part of surgical quality, the technical information regarding the surgical procedure is reflected only by the narrative operative report (NR), which has been found to be subjective and regularly omits important information. Objective To investigate systematic video recording (SVR) as a potential improvement in quality and safety with regard to important information in colorectal cancer surgery. Design, Setting, and Participants The Imaging for Quality Control Trial was a prospective, observational cohort study conducted between January 12, 2016, and October 30, 2017, at 3 centers in the Netherlands. The study group consisted of 113 patients 18 years or older undergoing elective laparoscopic surgery for colorectal cancer. These patients were case matched and compared with cases from a historical cohort that received only an NR. Interventions Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips. Main Outcomes and Measures The SVRs and NRs were analyzed for adequacy with respect to the availability of important information regarding the predefined key steps. Adequacy of the reported information was defined as the proportion of key steps with available and sufficient information in the report. Adequacy of the SVR and NR was compared between the study and control groups, with the SVR alone and as an adjunct to the NR in the study group vs NR alone in the control group. Results Of the 113 study patients, 69 women (61.1%) were included; mean (SD) age was 66.3 (9.8) years. In the control group, a mean (SD) of 52.5% (18.3%) of 631 steps were adequately described in the NR. In the study group, the adequacy of both the SVR (78.5% [16.5%], P < .001) and a combination of the SVR with NR (85.1% [14.6%], P < .001) was significantly superior to NR alone. The only significant difference between the study and historical control groups regarding postoperative and pathologic outcomes was a shorter postoperative mean (SD) length of stay in favor of the study group (8.0 [7.7] vs 8.6 [6.8] days; P = .03). Conclusions and Relevance Use of SVR in laparoscopic colorectal cancer surgery as an adjunct to the NR might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intraoperative information and contributing to quality control and objectivity.
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Affiliation(s)
- Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marilyne M Lange
- Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands
| | - Jolanda I Spakman
- Department of Surgery, Jeroen Bosch Hospitals, Hertogenbosch, the Netherlands
| | | | - Daan Lips
- Department of Surgery, Jeroen Bosch Hospitals, Hertogenbosch, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
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Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Non-neoplastic hepatopancreatobiliary lesions simulating malignancy: can we differentiate? Insights Imaging 2020; 11:21. [PMID: 32040641 PMCID: PMC7010905 DOI: 10.1186/s13244-019-0813-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 01/12/2023] Open
Abstract
Despite the success of cross-sectional imaging in evaluating hepatopancreatobiliary system malignancies, several non-malignant disease processes may closely mimic malignancy. Differentiating these benign diseases from malignancy may be difficult, or even impossible, even in the hands of experienced imagers. In this manuscript, we present benign mimics involving the hepatopancreatobiliary system and try to increase awareness of these potential pitfalls.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Bolat H, Teke Z. Spilled gallstones found incidentally in a direct inguinal hernia sac: Report of a case. Int J Surg Case Rep 2019; 66:218-220. [PMID: 31874379 PMCID: PMC6931096 DOI: 10.1016/j.ijscr.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/11/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. Iatrogenic gallbladder perforation and spillage of gallstones during LC is a frequent occurrence. There are many different clinical presentations of complications resulting from dropped gallstones. We herein present a case of scattered gallstones after LC encountered incidentally during a direct inguinal hernia repair. PRESENTATION OF CASE A 62-year-old male presented with a 4-year history of swelling of both right and left groins. He had undergone LC for acute calculous cholecystitis at another hospital 5 months earlier. Physical examination revealed reducible both right and left direct inguinal hernias. Surgical exploration of the right side revealed foreign bodies at the fundus of the sac attached to the inner wall, with a fibrotic reaction around it. On closer inspection these foreign bodies were macroscopically consistent with gallstones. The gallstones were removed, and bilateral herniotomies and Lichtenstein's prolene mesh repair were performed. Pathologic evaluation confirmed 10 foreign bodies of 5-mm in size to be cholesterol gallstones. DISCUSSION Gallstones have been very rarely reported previously within a hernia sac after LC. Most of the spilled gallstones are clinically silent and rarely become symptomatic. Complications may occur from the immediately postoperative period to a long time interval of 20 years. Treatment of complications is based on its type and location. CONCLUSION This case presents a very rare entity resulting from leaving spilled gallstones behind. We recommend that every effort should be made to retrieve any scattered stones during LC in order to avoid complications.
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Affiliation(s)
- Haci Bolat
- Nigde Omer Halisdemir University, Faculty of Medicine, Department of General Surgery, Nigde, Turkey.
| | - Zafer Teke
- Cukurova University, Faculty of Medicine, Department of Surgical Oncology, Adana, Turkey
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34
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Huynh R, Magdy M, Saliba L, Loi K. Retained gallbladder secondary to retrieval bag rupture during laparoscopic cholecystectomy-A case report. Int J Surg Case Rep 2019; 59:101-6. [PMID: 31125787 DOI: 10.1016/j.ijscr.2019.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Retrieval bags are used in laparoscopic cholecystectomies to reduce the risk of bile and gallstone spillage during removal of the gallbladder. Retrieval bag rupture is rare, and its complications have never been previously documented. PRESENTATION OF CASE A 17-year-old female presented three months post-laparoscopic cholecystectomy with a tender periumbilical mass. Her operative report noted difficulty removing the retrieval bag from the infra-umbilical port site. Imaging of the lump revealed an intra-abdominal fluid collection communicating with the umbilicus. A diagnostic laparoscopy uncovered significant pus in the peritoneal cavity and a gallbladder remnant with multiple gallstones. A combination of sharp and blunt dissections was used to free the gallbladder remnant from its adherent surroundings for removal. A peritoneal washout was performed following extraction of the retained gallstones. The patient's presentation could be traced back to her laparoscopic cholecystectomy where it was confirmed that the retrieval bag ruptured during removal. This would have transected the gallbladder, causing its remnants and associated gallstones to be retained in the peritoneal cavity. DISCUSSION Retrieval bag rupture can result in retained gallbladder remnants in the peritoneal cavity. Abdominal abscess can manifest months after the initial operation. CONCLUSION Retrieval bags should be inspected following removal to ensure it is completely intact. Surgeons should consider extending the fascial incision if there is any difficulty during removal. Any damage to the retrieval bag mandates immediate pneumoperitoneum for further exploration of retained products. Governance bodies should incorporate practice guidelines related to retrieval bag rupture as these are currently not present.
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Abstract
A 67-year-old lady was managed with percutaneous cholecystostomy for severe acute cholecystitis with septic shock. An interval laparoscopic subtotal cholecystectomy was done at 8 weeks. Her post-operative phase was complicated by intra-abdominal abscess requiring radiologically guided percutaneous drain insertion. Five days following the removal of the drain, she presented with a right abdominal wall abscess. A computerized tomography scan showed an abdominal wall ectopically-retained gallstone. The gallstone was retrieved along with drainage of abscess.
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Affiliation(s)
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Tonolini M, Ierardi AM, Patella F, Carrafiello G. Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists. Insights Imaging 2018; 9:925-941. [PMID: 30390275 PMCID: PMC6269337 DOI: 10.1007/s13244-018-0663-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/16/2018] [Accepted: 09/27/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract Performed on either an elective or urgent basis, cholecystectomy currently represents the most common abdominal operation due to the widespread use of laparoscopy and the progressively expanded indications. Compared to traditional open surgery, laparoscopic cholecystectomy minimised the duration of hospitalisation and perioperative mortality. Albeit generally considered safe, cholecystectomy may result in adverse outcomes with non-negligible morbidity. Furthermore, the incidence of worrisome haemorrhages and biliary complications has not been influenced by the technique shift. Due to the growing medico-legal concerns and the vast number of cholecystectomies, radiologists are increasingly requested to investigate recently operated patients. Aiming to increase familiarity with post-cholecystectomy cross-sectional imaging, this paper provides a brief overview of indications and surgical techniques and illustrates the expected early postoperative imaging findings. Afterwards, most iatrogenic complications following open, converted, laparoscopic and laparo-endoscopic rendezvous cholecystectomy are reviewed with examples, including infections, haematoma and active bleeding, residual choledocholithiasis, pancreatitis, biliary obstruction and leakage. Multidetector computed tomography (CT) represents the “workhorse” modality to rapidly investigate the postoperative abdomen in order to provide a reliable basis for an appropriate choice between conservative, interventional or surgical treatment. Emphasis is placed on the role of early magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive anatomic and functional assessment of the operated biliary tract. Teaching Points • Having minimised perioperative mortality and hospital stay, laparoscopy has now become the first-line approach to performing cholecystectomy, even in patients with acute cholecystitis. • Laparoscopic, laparo-endoscopic rendezvous, converted and open cholecystectomy remain associated with non-negligible morbidity, including surgical site infections, haemorrhage, residual lithiasis, pancreatitis, biliary obstruction and leakage. • Contrast-enhanced multidetector computed tomography (CT) is increasingly requested early after cholecystectomy and represents the “workhorse” modality that rapidly provides a comprehensive assessment of the operated biliary tract and abdomen. • Magnetic resonance cholangiopancreatography (MRCP) is the best modality to provide anatomic visualisation of the operated biliary tract and is indicated when biliary complications are suspected. • Additional gadoxetic acid (Gd-EOB-DTPA)-enhanced MRCP non-invasively provides functional biliary assessment, in order to confirm and visualise bile leakage.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
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McPherson I, McSorley ST, Cannings E, Shearer CJ, Crumley AB. Dropped gallstones causing abdominal wall abscess and pleural empyema: a case series. Scott Med J 2018; 64:67-70. [PMID: 30373501 DOI: 10.1177/0036933018807653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dropped gallstones are gallstones lost in the abdominal cavity during cholecystectomy. They are a rare occurrence and often cause minimal long-term issues. However, it is recognised that dropped stones can cause intra- or extra-abdominal sepsis. We present three cases below which highlight this. CASES All three cases describe patients presenting for laparoscopic cholecystectomy, Cases 1 and 2 post-gallstone pancreatitis and Case 3 for gallbladder stones. Cases 1 and 3 presented nine months and five years post-operatively, respectively, with flank abscess. Both received CT scans, with incision and drainage performed to remove gallstone. Case 2 presented six weeks post-operatively with cough and breathlessness. CT scan showed pleural effusion with communication to subphrenic collection. Pus and gallstone fragments were drained. CONCLUSION The above cases highlight that despite the majority of patients remaining asymptomatic, dropped gallstones should be considered amongst the differential in patients presenting with intra- or extra-abdominal abscess post-cholecystectomy, with timely intervention key to management.
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Affiliation(s)
- Iain McPherson
- 1 Foundation Doctor, Department of General Surgery, Forth Valley Royal Hospital, UK
| | - Stephen T McSorley
- 2 Specialty Trainee in General Surgery, Department of General Surgery, Forth Valley Royal Hospital, UK
| | - Elizabeth Cannings
- 3 Consultant General Surgeon, Department of General Surgery, Forth Valley Royal Hospital, UK
| | - Christopher J Shearer
- 4 Consultant General Surgeon, Department of General Surgery, Forth Valley Royal Hospital, UK
| | - Andrew Bc Crumley
- 5 Consultant General Surgeon, Department of General Surgery, Forth Valley Royal Hospital, UK
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Kennedy-Snodgrass C, Keenan V, Katz DS. Infected Renal Cyst as a Complication of Dropped Gallstones during Laparoscopic Cholecystectomy. Case Rep Gastrointest Med 2018; 2018:2478245. [PMID: 30405920 DOI: 10.1155/2018/2478245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Dropped gallstones are a relatively common complication, occurring in 3% to 32% of laparoscopic cholecystectomies performed, depending on various intraoperative risk factors. However, complications arising from dropped gallstones are relatively rare, occurring in fewer than 1% of such patients, and can include abscesses and inflammatory masses confined to the subhepatic space, presenting days to years later. We report a patient who developed an infected renal cyst as a result of dropped gallstones, which created a fistula from the duodenum to a previously simple right renal cyst, which was initially identified on an abdominal CT scan. Dropped gallstones can result in substantial morbidity in a minority of patients following cholecystectomy performed for cholecystitis, and a high clinical as well as radiological index of suspicion may be required for accurate early recognition and treatment.
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Tyagi V, Wiznia DH, Wyllie AK, Keggi KJ. Total Hip Lithiasis: A Rare Sequelae of Spilled Gallstones. Case Rep Orthop 2018; 2018:9706065. [PMID: 30013805 DOI: 10.1155/2018/9706065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Abstract
Laparoscopic cholecystectomy is associated with complications such as gallbladder perforation and spillage of gallstones. While these shortcomings are common, the occurrence of the resultant nuisances, such as intra-abdominal abscesses, is infrequent. We present the case of an individual who developed an intra-abdominal abscess following a spillage of gallstones, which occurred after a laparoscopic cholecystectomy that was performed more than a decade ago. Herein, we also discuss the findings of a literature review that highlights the clinical presentations of an intra-abdominal abscess formed due to gallstone spillage after a decade of the laparoscopic intervention. We also discuss the underlying pathophysiology leading to abscess formation, the imaging modalities used to visualize the abscess, as well as the therapeutic strategy used to treat this rare clinical entity.
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Affiliation(s)
- Aisha Akhtar
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Marvi M Bukhari
- Internal Medicine, Shifa College Of Medicine, Islamabad, PAK
| | - Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | | | | | | | - Amina Khan
- Internal Medicine, Shifa Tameer E Millat University/shifa International Hospital, Islamabad, PAK
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Garaud S, Stolz A. Dropped gallstones mimicking peritoneal metastasis: A case report. Radiol Case Rep 2018; 13:878-881. [PMID: 29988777 PMCID: PMC6031285 DOI: 10.1016/j.radcr.2018.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/17/2022] Open
Abstract
Dropped gallstones is a rare complication after a cholecystectomy. Computed tomography is the modality of choice for diagnosis. Dropped gallstones can be a fortuitous discovery in an asymptomatic patient but it is usually revealed when a complication occurs, most commonly through an abscess. Our case presents a dropped gallstone found during a routine check-up in a patient with a history of small bowel cancer. We will discuss differential diagnosis with others calcified peritoneal nodular patterns, particularly peritoneal carcinomatosis. We will recall the multimodality imaging findings of dropped gallstone and, based on literature, we will review the different sources of calcified peritoneal nodular pattern. The treatment of gallstone drop consequences depends on the clinical aspect.
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Affiliation(s)
- Sarah Garaud
- Department of radiology, Hôpital neuchâtelois, Rue de la Maladière 45, 2000 Neuchâtel, Switzerland
| | - Alexandre Stolz
- Department of radiology, Hôpital neuchâtelois, Rue de la Maladière 45, 2000 Neuchâtel, Switzerland
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Stroobants E, Cools P, Somville F. Case report: an unwanted leftover after laparoscopic cholecystectomy. Acta Chir Belg 2018; 118:196-198. [PMID: 28679321 DOI: 10.1080/00015458.2017.1346035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND A 72-year-old female patient with a history of laparoscopic cholecystectomy presented at the gastroenterology consultation with intermittent complaints of abdominal pain since two months in the right hemi abdomen. METHODS Imaging discovered a subhepatic abscess. Explorative surgery showed multiple gallstones as the cause of the abscess. A brief literature study was conducted and after a thorough selection based on title and abstract, we ended up with 14 articles. These were compared in the discussion with the literature concerning incidence, range of complications, risk factors and prevention and management. RESULTS Spilled gallstones are an unusual complication of a frequently performed procedure. CONCLUSIONS This case report elaborates on the incidence, different complications, prevention and management of spilled gallstones by means of a brief literature study. In case spillage happens removal of as many gallstones as possible is indicated the spillage should also be communicated to the patient to ease the diagnosis of a possible complication.
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Affiliation(s)
- Eline Stroobants
- Department of General, Digestive and Pediatric Surgery, Antwerp, Belgium
- Department of Emergency and Traumatology, Geel, Belgium
| | - Peter Cools
- Department of General, Digestive and Pediatric Surgery, Antwerp, Belgium
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Thomson B, Kawa B, Rabone A, Abdul-Aal Y, Hasan F, Ignotus P, Shaw A. Ultrasound-guided percutaneous retrieval of a dropped gallstone following laparoscopic cholecystectomy. BJR Case Rep 2018; 4:20180002. [PMID: 31489218 PMCID: PMC6711271 DOI: 10.1259/bjrcr.20180002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/09/2018] [Accepted: 03/30/2018] [Indexed: 11/09/2022] Open
Abstract
Removal of intraabdominal dropped gallstones remains a challenging problem for
both surgeon and radiologist. We describe in this report a novel, minimally
invasive technique to successfully remove a dropped gallstone, causing recurrent
intra-abdominal infection, from a patient who had undergone laparoscopic
cholecystectomy.
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Affiliation(s)
- Benedict Thomson
- Department of Interventional Radiology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Bhavin Kawa
- Department of Interventional Radiology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Amanda Rabone
- Department of Interventional Radiology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Yasser Abdul-Aal
- Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Fazal Hasan
- Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Paul Ignotus
- Department of Interventional Radiology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
| | - Aidan Shaw
- Department of Interventional Radiology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Pembury, UK
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Nugent L, Chandran P. Need brooks no delay. Peritoneo-cutaneous fistula formation secondary to gallstone dropped at laparoscopic cholecystectomy 20 years previously: a case report. J Surg Case Rep 2018; 2018:rjy013. [PMID: 29479416 PMCID: PMC5811847 DOI: 10.1093/jscr/rjy013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 11/14/2022] Open
Abstract
Dropped gallstones, in addition to inadvertent damage to the biliary tree, is a complication seen in laparoscopic cholecystectomy (LC) far more frequently than the open procedure. It can result in symptomatic abscess formation, and given its relative rarity, can present a diagnostic challenge. We present the case of a lady whose dropped gallstone resulted in a peritoneo-cutaneous fistula, over 20 years on from her LC.
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Affiliation(s)
- Luke Nugent
- Surgical Directorate, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, UK
| | - Palanichamy Chandran
- Surgical Directorate, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Canna A, Adaba F, Sezen E, Bissett A, Finch GJ, Ihedioha U. Para-spinal abscess following gallstones spillage during laparoscopic cholecystectomy: an unusual presentation. J Surg Case Rep 2017; 2017:rjx052. [PMID: 28458858 PMCID: PMC5400479 DOI: 10.1093/jscr/rjx052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
Gallbladder perforation with subsequent gallstone spillage can occur with higher frequency in laparoscopic cholecystectomy than in traditional open approach. Gallstone abscess formation from stone spillage post-cholecystectomy is extremely rare. We present a case of para-spinal abscess formation 5 years after spilled gallstones following laparoscopic cholecystectomy.
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Affiliation(s)
- A. Canna
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - F. Adaba
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - E. Sezen
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - A. Bissett
- Department of Radiology, Northampton General Hospital, Northampton, UK
| | - GJ. Finch
- Department of General Surgery, Northampton General Hospital, Northampton, UK
| | - U. Ihedioha
- Department of General Surgery, Northampton General Hospital, Northampton, UK
- Corresponding address. Department of General Surgery, Northampton General Hospital, Northampton NN1 5BD, UK.
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Jabbari Nooghabi A, Hassanpour M, Jangjoo A. Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article. Surg Laparosc Endosc Percutan Tech 2016; 26:183-92. [PMID: 27258908 DOI: 10.1097/SLE.0000000000000274] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Kumar S. Peritoneo-cutaneous fistula from spilled gall bladder calculus following laparoscopic cholecystectomy. Clin Case Rep 2017; 5:720-722. [PMID: 28469884 PMCID: PMC5412758 DOI: 10.1002/ccr3.903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Inadvertent spillage of gall stones is a rare yet important cause of delayed postcholecystectomy complications. Varied presentations and difficulty in diagnosis are the hallmarks, making it crucial to have a high index of suspicion to detect and intervene appropriately. Peritoneo‐cutaneous fistulae from the retained stone can be completely excised in toto.
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Affiliation(s)
- Suneed Kumar
- Department of General Surgery Grant Govt. Medical College & Sir JJ Group of Hospitals Mumbai 400007 Maharashtra India
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Faour R, Sultan D, Houry R, Faour M, Ghazal A. Gallstone-related abdominal cystic mass presenting 6 years after laparoscopic cholecystectomy: A case report. Int J Surg Case Rep 2017; 32:70-72. [PMID: 28257913 PMCID: PMC5333506 DOI: 10.1016/j.ijscr.2017.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Although gallbladder perforation and gallstones spillage are common complications during laparoscopic cholecystectomy (LC), clinically significant complications resulting from stones left in the peritoneum are extremely uncommon. We report a rare case of spilled gallstones complication with a late and uncharacteristic presentation. PRESENTATION OF THE CASE A 44-year-old Caucasian female presented with a complaint of a mass in the right upper quadrant associated with a cramping pain for the last 6 months. Her past surgical history included a laparoscopic cholecystectomy performed six years ago. Abdominal computed tomography demonstrated an intra-abdominal cystic mass. On open exploration, a cystic mass adhered to the abdominal wall was excised containing two gallstones. The patient tolerated the procedure well and had uneventful postoperative recovery. DISCUSSION Although unretrieved gallstones are considered harmless, serious complications can occur early or late. The most frequent complication is the formation of abscesses in different locations. CONCLUSION The diagnosis of gallstone abscess after years of LC is usually a diagnostic challenge. Obtaining a comprehensive past surgical history still plays an important role in the assessment of patients presenting with unusual findings.
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Affiliation(s)
- Rama Faour
- University of Aleppo, Faculty of Medicine, Aleppo, Syria.
| | - Dana Sultan
- University of Aleppo, Faculty of Medicine, Aleppo, Syria
| | - Rand Houry
- University of Aleppo, Faculty of Medicine, Aleppo, Syria
| | | | - Ahmad Ghazal
- Department Of General Surgery, Aleppo University Hospital, Aleppo, Syria
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Ragozzino A, Puglia M, Romano F, Imbriaco M. Intra-Hepatic Spillage of Gallstones as a Late Complication of Laparoscopic Cholecystectomy: MR Imaging Findings. Pol J Radiol 2016; 81:322-4. [PMID: 27471576 PMCID: PMC4943473 DOI: 10.12659/pjr.896497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/04/2015] [Indexed: 11/29/2022] Open
Abstract
Background Spillage of gallstones in the abdominal cavity may rarely occur during the course of laparoscopic cholecystectomy. Dropped gallstones in the peritoneal and extra-peritoneal cavity are usually asymptomatic. However, they may lead to abscess formation with an estimated incidence of about 0.3%. Common locations of the abscess are in the abdominal wall followed by the intra-abdominal cavity, usually in the sub-hepatic or retro-peritoneum inferior to the sub-hepatic space. Case Report We hereby describe an unusual case of infected spilled gallstones in the right sub-phrenic space, prospectively detected on abdominal MRI performed two years after laparoscopic cholecystectomy, in a patient with only a mild right-sided abdominal complaint. Conclusions This case highlights the role of MRI in suggesting the right diagnosis in cases with vague or even absent symptomatology. In our case the patient’s history together with high quality abdomen MRI allowed the correct diagnosis. Radiologists should be aware of this rare and late onset complication, even after many years from surgery as an incidental finding in almost asymptomatic patients.
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Affiliation(s)
- Alfonso Ragozzino
- Department of Radiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Marta Puglia
- Department of Advanced Biomedical Imaging, University Federico II, Napoli, Italy
| | - Federica Romano
- Department of Radiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
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