Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report.

BACKGROUND: Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC. CASE PRESENTATION: We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up. CONCLUSIONS: We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.

A Case of Intractable Lung Abscess Following Dropped Gallstone-Induced Subphrenic Abscess: A Rare Postoperative Complication Caused by Dropped Gallstone During Laparoscopic Cholecystectomy.

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.

Dropped Gallstone Presenting as Recurrent Abdominal Wall Abscess.

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.

Foreign-body granulomas and abscesses caused by dropped gallstones after cholecystectomy: Four cases diagnosed with multimodality imaging.

Four cases (age range, 60-78 years, male:female = 1:3) who had undergone cholecystectomy presented with fever (n = 1), right abdominal pain with fever (n = 1), appetite loss with fever (n = 1), and absence of symptoms (n = 1). Computed tomography (CT) showed an irregular-shaped invasive mass or fluid collection in the right Morrison's pouch, right paracolic gutter, gallbladder fossa, subphrenic space, or abdominal wall. CT and ultrasound revealed gallstones in the granuloma in 3 cases and an abscess in one case. The inflammatory process induced by dropped gallstones may mimic peritoneal malignancies. Awareness of cholecystectomy and the detection of gallstones in the lesion are essential for the diagnosis of dropped gallstones.

Hallazgos imagenológicos en cálculos abandonados en cavidad abdominal después de colecistectomía laparoscópica: serie de 7 casos y revisión de la literatura / Imaging Findings of Stones Left in the Abdominal Cavity Following Laparascopic Cholecystectomy: A Series of Seven Cases and Literature Review

Resumen La colecistectomía laparoscópica (CL) es la técnica quirúrgica de elección actual para el tratamiento de la colelitiasis sintomática. Sin embargo, este procedimiento acarrea ciertas complicaciones, dentro de las cuales destacamos la perforación de la vesícula biliar con subsiguiente caída de los cálculos y bilis a la cavidad peritoneal, que puede dar origen a la formación de abscesos abdominales tiempo después de dicho procedimiento quirúrgico. Por tal motivo, los cálculos biliares abandonados deben reconocerse como una fuente potencial para la formación de un proceso inflamatorio intraabdominal, en especial cuando se tiene historia de perforación vesicular durante el procedimiento, o en los casos de conversión a colecistectomía abierta y caída de los cálculos a la cavidad peritoneal. Tanto los radiólogos como los cirujanos deben familiarizarse con los hallazgos imagenológicos de las diferentes modalidades diagnósticas, como el ultrasonido, la TC y la resonancia magnética, así como con las diferentes manifestaciones clínicas que pueden presentarse. En esta publicación, presentamos los casos de 7 pacientes con antecedente de colecistectomía laparoscópica que acudieron al servicio de urgencia de nuestro hospital por dolor abdominal y en quienes los hallazgos imagenológicos determinaron la presencia de colecciones perihepáticas por cálculos caídos.

Abstract Laparascopic cholecystectomy (LC) is the current surgical technique of choice for the treatment of symptomatic cholelithiasis. However, this procedure leads to certain complications, of which we highlight gallbladder perforation with the subsequent spillage of stones and bile into the peritoneal cavity, which may give rise to the formation of abdominal abscesses some time after the surgery. For this reason, abandoned gallstones should be recognized as a potential source of intra-abdominal inflammatory processes, especially when there is a history of gallbladder perforation during the procedure, or in cases of conversion to open cholecystectomy and spillage of gallstones into the peritoneal cavity. Both radiologists as well as surgeons should be familiar with the imaging findings of the various diagnostic modalities such as ultrasound, CT and magnetic resonance imaging, as well as the various clinical manifestations that can present. In this publication we present 7 cases of patients with a history of laparascopic cholecystectomy who presented to our hospital´s ER with abdominal pain and in whom the imaging findings showed the presence of perihepatic collections caused by spilled stones.

Combined percutaneous and endoscopic approach in management of dropped gallstones following laparoscopic cholecystectomy.

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.