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Husnain A, Reiland A, Nemcek AA, Salem R, Nagle AP, Teitelbaum E, Riaz A. Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series. Surg Laparosc Endosc Percutan Tech 2024:00129689-990000000-00225. [PMID: 38736370 DOI: 10.1097/sle.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/21/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition. MATERIALS AND METHODS We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.5 years [68 to 82]) presenting with recurrent or chronic intra-abdominal abscesses secondary to dropped gallstones. Technical success was defined as the visualization and retrieval of all stones. DGs were identified on pre-procedure imaging. Number of abscesses recurrence was 12 (1/6), 1 (3/6), and 0 (2/6) with a median interval of 2 months (1 to 21) between cholecystectomy and abscess development. RESULTS Percutaneous endoscopy and fluoroscopy guidance were utilized in all cases. Technical success was achieved in 4 patients (66%). The median procedure time was 65.8 minutes (39 to 136). The median fluoroscopy time and dose were 12.6 min (3.3 to 67) and 234 mGy (31 to 1457), respectively. There were no intraprocedure and postprocedure complications. No abscess recurrence was reported among successful procedures during a median follow-up of 193 days (51 to 308). CONCLUSION Percutaneous image and endoscopy-guided lithotripsy/lithectomy are safe and effective. This technique is a suitable alternative to open surgery for dropped gallstones. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Ali Husnain
- Department of Radiology, Section of Interventional Radiology
| | - Allison Reiland
- Department of Radiology, Section of Interventional Radiology
| | - Albert A Nemcek
- Department of Radiology, Section of Interventional Radiology
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology
| | | | - Ezra Teitelbaum
- Department of Surgery, Northwestern Memorial Hospital, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
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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] [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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Zeledón-Ramirez M, Siles-Chaves I, Sánchez-Cabo A. Case report: Dropped gallstones diagnosis is hindered by incomplete surgical notes and a low index of suspicion. Int J Surg Case Rep 2022; 93:106965. [PMID: 35381548 PMCID: PMC8980749 DOI: 10.1016/j.ijscr.2022.106965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Manuel Zeledón-Ramirez
- Early Cancer Detection Center, Max Peralta Hospital, Caja Costarricense de Seguro Social, Cartago (C.C.S.S.), Costa Rica.
| | - Iván Siles-Chaves
- Early Cancer Detection Center, Max Peralta Hospital, Caja Costarricense de Seguro Social, Cartago (C.C.S.S.), Costa Rica
| | - Alexander Sánchez-Cabo
- Early Cancer Detection Center, Max Peralta Hospital, Caja Costarricense de Seguro Social, Cartago (C.C.S.S.), Costa Rica
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Hey, you forgot something! The Management of Symptomatic Retained Gallstones. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2021.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hennebry J, Stroiescu A, Bolger M, Byrne C, Cross K, Ryan A. Avoidance of Nephrectomy and Percutaneous Extraction of Retroperitoneal Calculi Secondary to Xanthogranulomatous Pyelonephritis. J Vasc Interv Radiol 2020; 32:324-327. [PMID: 33309280 DOI: 10.1016/j.jvir.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jennifer Hennebry
- Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
| | - Andreea Stroiescu
- Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
| | - Mark Bolger
- Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
| | - Caoimhe Byrne
- Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
| | - Keith Cross
- Department of Surgery, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
| | - Anthony Ryan
- Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Dunmore Road, Waterford City, X91 ER8E, Ireland
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Spilled gallstones simulating peritoneal carcinomatosis: A case report and literature review. Int J Surg Case Rep 2018; 48:113-121. [PMID: 29885915 PMCID: PMC6041376 DOI: 10.1016/j.ijscr.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) has become the "gold standard" for the treatment of symptomatic gallstones. However, this surgical technique increases the risk of bile duct injury and lost gallstones. Since over 90% of split gallstones never become symptomatic, they often present as incidental findings on CT-scans. Careful removal of as many stones as possible, intense irrigation and suction are recommended. It has been reported that 8.5% of lost gallstones will lead to a complication, most common are abscesses. PRESENTATION CASE We report a case of spilled gallstones simulating peritoneal metastases on radiological investigations. Diagnosis was very difficult, not even an US-guided biopsy of the lesion was decisive. Only a diagnostic laparoscopy confirms the diagnosis. DISCUSSION The reaction associated with lost gallstones can mimic other causes, such as soft tissue sarcoma, malignant lymphoma or, as in our case peritoneal carcinomatosis. CONCLUSION Spilled gallstones are associated with uncommon, but significant complications, and even the diagnosis of such a condition can cause serious difficulties. Serious effort must be made to prevent gallbladder perforation, and accidental stone spillage should be promptly recognized and properly managed.
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Affiliation(s)
- G T Capolupo
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - G Mascianà
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy.
| | - F Carannante
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
| | - M Caricato
- Geriatric Surgery Unit, University Campus Bio-medico of Rome, Rome, Italy
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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] [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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Koichopolos J, Hamidi M, Cecchini M, Leslie K. Gastric outlet obstruction by a lost gallstone: Case report and literature review. Int J Surg Case Rep 2017; 41:128-131. [PMID: 29073549 PMCID: PMC5655411 DOI: 10.1016/j.ijscr.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Spilled gallstones from a laparoscopic cholecystectomy can be a source of significant morbidity, most commonly causing abscesses and fistulae. Preventative measures for loss, careful removal during the initial surgery, and good documentation of any concern for remaining intraperitoneal stones needs to be performed with the initial surgery. CASE REPORT An 80-year-old male with a history of complicated biliary disease resulting in a cholecystectomy presented to general surgery clinic with increasing symptoms of gastric outlet obstruction. CT imaging was concerning for a malignant process despite negative biopsies. A distal gastrectomy and Billroth II reconstruction was performed and final pathology showed dense inflammation with a single calcified stone incarcerated within the gastric wall of the inflamed pylorus and no malignancy. DISCUSSION Stones lost during laparoscopic cholecystectomy are not innocuous and preventative measures for loss, careful removal during the initial surgery, and good documentation of any concern for remaining intraperitoneal stones. CONCLUSION This is the first case of gastric outlet obstruction caused by an intramural obstruction of the pylorus from a spilled gallstone during a laparoscopic cholecystectomy and subsequent inflammation. This is an etiology that must be considered in new cases of gastric outlet obstruction and can mimic malignancy.
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Affiliation(s)
- Jennifer Koichopolos
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Moska Hamidi
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew Cecchini
- Department of Surgery, London Health Sciences Center, London, ON, Canada; Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kenneth Leslie
- Department of Surgery, London Health Sciences Center, London, ON, Canada
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Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article. Surg Laparosc Endosc Percutan Tech 2017; 26:183-92. [PMID: 27258908 DOI: 10.1097/sle.0000000000000274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC. METHODS We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications. RESULTS Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions. CONCLUSIONS Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
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12
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Abstract
INTRODUCTION Bile and gallstones are spilled during 13% to 40% of all laparoscopic cholecystectomies. They can act as a septic focus and cause complications. We present 2 cases of perihepatic abscess formation due to dropped gallstones presenting some years later. Delayed diagnosis resulted in unnecessary investigations and had negative economic consequences. CASE DESCRIPTION In 1 patient a posterolateral cutaneous fistula had developed that was initially biopsied by cardiothoracic surgeons before computed tomography showed the cause. The other patient presented with recurrent Pyrexia of unknown origin (PUO) causing repeated absence from work and was diagnosed only after 18 months of medical investigation. Both patients were treated with laparoscopic drainage of the abscess and successful retrieval of all stones. DISCUSSION Radiologic and open drainage and retrieval of stones have been well described in these cases. We suggest that a laparoscopic approach is superior because the cavity can be clearly identified and stones visualized and removed under direct vision. The need for a formal laparotomy is avoided. We also highlight the economic burden to both patient and health care professional of delayed diagnosis, as shown in these 2 cases. Spilled gallstones are a recognized complication of laparoscopic cholecystectomy. All stones should be actively sought and removed to avoid complications. Laparoscopic drainage is preferable to open or radiologic drainage. Dropped gallstones should be considered a possible diagnosis in patients who have had a previous cholecystectomy and present with unusual symptoms.
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Affiliation(s)
- Rajeev Peravali
- Department of General Surgery, Hinchingbrooke Hospital NHS Trust, Huntingdon, UK.
| | - Adrian Harris
- Department of General Surgery, Hinchingbrooke Hospital NHS Trust, Huntingdon, UK
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Out of Sight but Kept in Mind: Complications and Imitations of Dropped Gallstones. AJR Am J Roentgenol 2013; 200:1244-53. [DOI: 10.2214/ajr.12.9430] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Hegarty C, Heaslip I, Murphy M, McDermott EW, Brophy DP. Percutaneous Removal of a Dropped Appendicolith Using a Basket Retrieval Device and Concomitant Abscess Drainage. J Vasc Interv Radiol 2012; 23:568-70. [DOI: 10.1016/j.jvir.2011.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/01/2011] [Accepted: 12/08/2011] [Indexed: 11/28/2022] Open
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Papadopoulos IN, Christodoulou S, Economopoulos N. Asymptomatic omental granuloma following spillage of gallstones during laparoscopic cholecystectomy protects patients and influences surgeons' decisions: a review. BMJ Case Rep 2012; 2012:bcr.10.2011.4980. [PMID: 22665910 DOI: 10.1136/bcr.10.2011.4980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Spillage of gallstones in the peritoneal cavity during laparoscopic cholecystectomy (LC) occurs at rates varying from 5.7% to 16%. These gallstones often cannot be retrieved and can cause early and late abscesses at rates ranging from 0.08% to 1.4%. The case of an 86-year-old woman with colon cancer is described because during an elective right hemicolectomy a granuloma of the omentum with retained gallstones from LC performed 8 years earlier was unexpectedly found. Importantly, the gallstones were found high up in the abdominal cavity. Moreover, this report reaffirms the excellent response of the peritoneal cavity defence mechanisms for protecting patients against gallstones through asymptomatic omental granuloma. Current data indicate that every effort should be made to retrieve spilled gallstones, but routine conversion to an open cholecystectomy is not recommended. Identifying factors that impair host defence mechanisms should help surgeons' decision-making.
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Affiliation(s)
- Iordanis N Papadopoulos
- Fourth Surgery Department, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Park JI, Hur CY, Kim JS, Kim KH, Kim KH, Park OH, Choi CS, Choi YK. Percutaneous Removal of Spilled Gallstones after Laparoscopic Cholecystectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.1.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong-Ik Park
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chan-Young Hur
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin-Soo Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki-Hun Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwang-Hee Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Oh-Hwan Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Soo Choi
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Kil Choi
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Shum JSF, Fung KH, Yang GPC, Tang CN, Li MKW. Combined percutaneous and endoscopic approach in management of dropped gallstones following laparoscopic cholecystectomy. J Radiol Case Rep 2010; 4:1-5. [PMID: 22470740 DOI: 10.3941/jrcr.v4i7.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dropped gallstones due to accidental perforation of gallbladder wall during laparoscopic cholecystectomy are often encountered. However, dropped gallstones as nidus of infection with subsequent abscess formation is a rare complication of laparoscopic cholecystectomy (0.3%). Most of the reported cases of complicated dropped stones required open surgical drainage. Minimally invasive measures were less frequently employed. We report a case of dropped gallstones that were removed endoscopically through a percutaneous drainage tract.
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Affiliation(s)
- John S F Shum
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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Castellón-Pavón CJ, Morales-Artero S, Martínez-Pozuelo A, Valderrábano-González S. Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica. Cir Esp 2008; 84:3-9. [DOI: 10.1016/s0009-739x(08)70596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Khalid M, Rashid M. Gallstone abscess: a delayed complication of spilled gallstone after laparoscopic cholecystectomy. Emerg Radiol 2008; 16:227-9. [PMID: 18481124 DOI: 10.1007/s10140-008-0730-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 04/07/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Mohd Khalid
- Department of Radio Diagnosis, JN Medical College, AMU, Uttar Pradesh, India
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Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007; 193:73-8. [PMID: 17188092 DOI: 10.1016/j.amjsurg.2006.05.015] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones. DATA SOURCES A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones. CONCLUSION Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.
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Affiliation(s)
- Jörg Zehetner
- Department of Surgery, Ludwig Boltzmann Institute for Operative Laparoscopy, AKH Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
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Villar del Moral JM, Villegas-Herrera MT, Medina-Benítez A, Ramia-Angel JM, Garrote-Lara D, Ferrón-Orihuela JA. Retroperitoneoscopy to Extract Dropped Gallstones After Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2006; 16:290-3. [PMID: 16796443 DOI: 10.1089/lap.2006.16.290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.
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Boschi J. Complicación alejada de colecistectomía laparoscópica: absceso por litiasis biliar perdida. RADIOLOGIA 2004. [DOI: 10.1016/s0033-8338(04)77984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Papasavas PK, Caushaj PF, Gagné DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2002; 12:383-6. [PMID: 12470414 DOI: 10.1089/109264202320884144] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spilled gallstones have emerged as a new issue in the era of laparoscopic cholecystectomy. We treated a 77-year-old woman who underwent laparoscopic cholecystectomy. Subsequently, a right flank abscess developed. During the cholecystectomy, the gallbladder was perforated and stones were spilled. After a failed attempt to drain the abscess percutaneously, the patient required open drainage, which revealed retained gallstones in the right flank. The abscess resolved, although the patient continued to have intermittent drainage without evidence of sepsis. Review of the literature revealed 127 cases of spilled gallstones, of which 44.1% presented with intraperitoneal abscess, 18.1% with abdominal wall abscess, 11.8% with thoracic abscess, 10.2% with retroperitoneal abscess, and the rest with various clinical pictures. In case of gallstone spillage during laparoscopic cholecystectomy, every effort should be made to locate and retrieve the stones.
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Affiliation(s)
- Pavlos K Papasavas
- Temple University Clinical Campus at The Western Pennsylvania Hospital, Department of Surgery, Pittsburgh, Pennsylvania 15224, USA.
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Percutaneous Treatment of Gallstone Abscess After Laparoscopic Cholecystectomy Using Fistuloscopy. Surg Laparosc Endosc Percutan Tech 2001. [DOI: 10.1097/00129689-200106000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- M J McCLURE
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada.
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Retroperitoneal Abscess After Retained Stones During Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2000. [DOI: 10.1097/00129689-200004000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preciado A, Matthews BD, Scarborough TK, Marti JL, Reardon PR, Weinstein GS, Bennett M. Transdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 1999; 9:517-21. [PMID: 10632515 DOI: 10.1089/lap.1999.9.517] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.
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Affiliation(s)
- A Preciado
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH. Iatrogenic Gallbladder Perforation during Laparoscopic Cholecystectomy: Etiology and Sequelae. Am Surg 1999. [DOI: 10.1177/000313489906501010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Iatrogenic perforation of the gallbladder (PGB) during laparoscopic cholecystectomy (LC) leads to spillage of bile and gallstones into the peritoneal cavity, which can result in serious postoperative infection. The objective of this study is to prospectively evaluate with long-term follow-up the risk factors, mechanisms, and complications associated with PGB in patients undergoing LC. Data from 1412 patients undergoing LC were collected prospectively between 1989 and 1995. Patients with and without iatrogenic gallbladder perforation were compared. Long-term follow-up was obtained using mailed questionnaires and telephone interviews, when needed. Of the 1412 patients, 512 (36%) sustained a PGB. Male sex, weight, gallbladder inflammation, thickening of the gallbladder, presence of adhesions, and a difficult hilar dissection were all associated with an increased incidence of PGB. The most common mechanisms of PGB were laceration due to grasper traction (55%) and electrocautery dissection (40%). Both the operating time and length of hospital stay were significantly longer in the PGB group. No difference was observed in the rate of wound infections between PGB and non-PGB patients (1.6% versus 1.8%). Only one patient (with an inflamed and perforated gallbladder) developed an early postoperative intra-abdominal abscess. Long-term follow-up averaging 48 months was achieved with a response rate of 44 per cent. No late intra-abdominal abscesses or complications attributable to retained gallstones were discovered.
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Affiliation(s)
- Thomas T. Hui
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dan I. Giurgiu
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sumito Takagi
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Atsushi Iida
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Division of General Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Torres OJM, Valadão JA, Silva AJR, Macau RP, Cintra JCA, Dietz UA, Nassif PAN. EFEITO DE CÁLCULOS BILIARES HUMANOS NA CAVIDADE PERITONEAL DE RATOS. Acta Cir Bras 1998. [DOI: 10.1590/s0102-86501998000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo tem por objetivo analisar experimentalmente as características macroscópicas e microscópicas de cálculos biliares humanos na cavidade peritoneal de ratos. Foram utilizados 32 ratos Wistar, machos, pesando entre 205 e 268 g. Estes animais foram distribuídos em dois grupos e o procedimento cirúrgico foi realizado em cada grupo: no grupo A (n =16), os animais foram submetidos a manipulação intestinal; no grupo B (n=16), cálculos biliares humanos foram colocados na cavidade peritoneal. Os ratos foram avaliados no 21º e 42º dias do período pós-operatório. Os resultados mostraram que a simples manipulação causou aderências nos animais (n=10). As aderências foram notadas em 11 cálculos no grupo B. Histologicamente não houve fibrose intensa em torno do cálculo, principalmente no 42º dia do período pós-operatório. Não foram observados macro ou micro abscessos e não houve evidências de fluído livre intra-peritoneal. Este estudo demonstra que apesar da baixa incidência de complicações, todas as tentativas devem ser feitas para recuperar cálculos perdidos durante colecistectomia.
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Horton M, Florence MG. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am J Surg 1998; 175:375-9. [PMID: 9600281 DOI: 10.1016/s0002-9610(98)00048-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. METHODS Between 1993 and 1995, 1,130 laparoscopic cholecystectomies were performed at two major metropolitan medical centers. Of these patients, we know of 3 (0.3%) who subsequently developed abscesses as a consequence of dropped stones during the laparoscopic cholecystectomy. One additional patient who underwent prior laparoscopic cholecystectomy at another institution developed late infection as well. RESULTS All 4 patients developed late purulent abscesses that ultimately required open surgical drainage, and 1 patient developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. Significant costs were involved in the diagnosis, management, and duration of therapy for these problems. CONCLUSIONS This experience closely resembles that of other centers and points out the existence of a late postoperative complication following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies for avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of laparoscopic cholecystectomy with or without placement of a drain in the subhepatic space does not prevent this complication.
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Affiliation(s)
- M Horton
- Department of Surgery, Swedish Medical Center, Seattle, Washington, USA
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Parra-Davila E, Munshi IA, Armstrong JH, Sleeman D, Levi JU. Retroperitoneal abscess as a complication of retained gallstones following laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 1998; 8:89-93. [PMID: 9617969 DOI: 10.1089/lap.1998.8.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Retroperitoneal abscess formation secondary to retained spilled gallstones after laparoscopic cholecystectomy is a rare complication. We describe the case of a patient with this complication as well as a novel method utilizing interventional radiologic localization with subsequent operative drainage and removal of the stones. A review of the literature is provided.
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Affiliation(s)
- E Parra-Davila
- Department of Surgery, University of Miami, Jackson Memorial Hospital, Florida 33101, USA
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Akyar G, Aytaç S, Yağci C, Akyar S. Abscess formation due to dropped gallstone after laparoscopic cholecystectomy. Eur J Radiol 1997; 25:242-5. [PMID: 9430832 DOI: 10.1016/s0720-048x(96)01147-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Laparoscopic cholecystectomy is a popular treatment modality of symptomatic gallstones with decreased major complications and shortened hospital stay. Complications following laparoscopic cholecystectomy, most of them involving strictures of biliary tract have been well described in recent reports. However, there are only a few reported cases about dropped gallstones after the procedure, all of which were opaque and easily demonstrated with multiple imaging modalities. An unusual complication of laparoscopic cholecystectomy; abscess formation due to a dropped non-opaque gallstone is described in which diagnosis was suggested with the combination of ultrasound and computed tomography findings and confirmed by surgery.
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Affiliation(s)
- G Akyar
- University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Department of Radiology, Turkey
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Hashimoto M, Watanabe G, Matsuda M, Ueno M, Tsurumaru M. Abscesses caused by "dropped" stones after laparoscopic cholecystectomy for cholelithiasis: a report of three cases. Surg Today 1997; 27:364-7. [PMID: 9086557 DOI: 10.1007/bf00941815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
While laparoscopic cholecystectomy is a standard therapeutic option for gallbladder stones, it is associated with a significant risk of injury to the gallbladder wall, which may result in the dispersion of free stones within the peritoneal cavity. However, the incidence and consequences of these dropped stones remains unclear. We report herein the cases of three patients in whom abdominal abscesses developed as a result of dropped stones during this procedure. Of particular interest was the relatively long interval from the procedure to the onset of symptoms and the unusual progression of the inflammation. These case reports strongly reinforce the risk of dropped stones during laparoscopic cholecystectomy.
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Affiliation(s)
- M Hashimoto
- Department of Surgery, Toranomon Hospital, Tokyo, Japan
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Neumeyer DA, LoCicero J, Pinkston P. Complex pleural effusion associated with a subphrenic gallstone phlegmon following laparoscopic cholecystectomy. Chest 1996; 109:284-6. [PMID: 8549202 DOI: 10.1378/chest.109.1.284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A 90-year-old man presented with a large right-sided complex pleural effusion 4 months after a laparoscopic cholecystectomy. An initial thoracic CT scan confirmed the presence of the effusion, and the results of thoracentesis on three separate occasions were consistent with an exudative process. Another CT scan of the chest with thin-section cuts through the diaphragm along with an abdominal ultrasound revealed a retrohepatic subdiaphragmatic gallstone collection that eroded into the right hemidiaphragm. Thoracoscopic evacuation of the phlegmon, removal of the spilled gallstones, and repair of the diaphragm resulted in resolution of the effusion.
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Affiliation(s)
- D A Neumeyer
- Division of Pulmonary and Critical Care Medicine, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215, USA
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Rawson JV, Klein RM, Hodgson J. "Dropped" surgical clips following laparoscopic cholecystectomy. Surg Endosc 1996; 10:77-8. [PMID: 8711615 DOI: 10.1007/s004649910021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Rosin D, Korianski Y, Yudich A, Ayalon A. Lost gallstones found in a hernial sac. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:409-11. [PMID: 8746995 DOI: 10.1089/lps.1995.5.409] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Spillage of bile and gallstones is not a rare event during laparoscopic cholecystectomy. The natural history of spilled and retained stones is not well defined. We report of such lost stones that were found several months later in a hernia sac.
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Affiliation(s)
- D Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel
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Affiliation(s)
- N Tait
- University of Sydney Department of Surgery, Westmead Hospital, New South Wales, Australia
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Targarona EM, Balagué C, Cifuentes A, Martínez J, Trías M. The spilled stone. A potential danger after laparoscopic cholecystectomy. Surg Endosc 1995; 9:768-73. [PMID: 7482182 DOI: 10.1007/bf00190079] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The application of laparoscopic techniques in digestive surgery to areas in which there was no previous experience has favored the appearance of new complications and clinical situations that were not observed during the open era. Initial opinion considered that stones left in the abdominal cavity were harmless, and a few clinical and experimental studies supported this opinion. But cumulative reports of cases suggest a potential danger. From 1991 to date, 49 cases of complications related to stones left in the abdominal cavity have been reported with severe complications that required an open surgical procedure. Stone spillage has not always been considered an indication of conversion of laparoscopic cholecystectomy but is now accepted as a source of infrequent but severe complications that may require a reintervention for treatment. Therefore it is recommended that efforts should be made to retrieve all spilled stones; the surgical procedure should be prolonged until this is achieved, in order to reduce one source of unpredictable morbidity. Open retrieval should be considered in selected cases if a large number or large stones are lost.
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Affiliation(s)
- E M Targarona
- Service of Surgery, Hospital Clinic, University of Barcelona, Spain
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Maldjian C, Stancato-Pasik A, Shapiro RS. Abscess formation as a late complication of dropped gallstones. ABDOMINAL IMAGING 1995; 20:217-8. [PMID: 7620409 DOI: 10.1007/bf00200398] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a case of abscess formation 1.5 years postoperatively in a patient with dropped gallstones from laparoscopic cholecystectomy. The entity was initially recognized on computed tomography (CT) and the diagnosis was confirmed with ultrasound. Although this is a rare complication of laparoscopic cholecystectomy, it should be recognized as a potential source of abscess formation even in a patient presenting months after the procedure.
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Affiliation(s)
- C Maldjian
- Department of Radiology, Mount Sinai Medical Center, New York, NY 10029, USA
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Thompson J, Pisano E, Warshauer D. Cholelithoptysis: an unusual complication of laparoscopic cholecystectomy. Clin Imaging 1995; 19:118-21. [PMID: 7773874 DOI: 10.1016/0899-7071(94)00038-e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic cholecystectomy is emerging as a preferred surgical method in the treatment of cholecystitis. Decreased morbidity and mortality rates make this an attractive alternative to conventional cholecystectomy. Recently, specific complications including bile duct transection, biloma formation, and liver lacerations have been reported. We report here, however, an unusual case of intraoperative spillage of stones into the intraperitoneal cavity. Subsequent erosion through the diaphragm resulted in expectoration of stones, or cholelithoptysis.
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Affiliation(s)
- J Thompson
- Department of Diagnostic Radiology, University of North Carolina at Chapel Hill 27599, USA
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