Abstract
Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs frequently, but clinical sequelae caused by dropped gallstones are uncommon. We present a case of subhepatic and right-back abscess formation due to spilled gallstones occurring two years after LC, which were successfully removed using a percutaneous method as a minimally invasive technique. The patient firstly visited a primary care physician with right-back mass that was increasing in size and becoming symptomatic, then underwent incision and drainage. He was referred to our hospital and the subhepatic and right-back inflammatory mass containing spilled gallstones was revealed by computed tomography. Under fluoroscopic control, a percutaneous drainage catheter was placed within the abscess and pus was aspirated. The spilled gallstones were successfully retrieved with basket forceps, thereafter. The patient was discharged without significant complications on the 9th day after the percutaneous stone removal.
References
1. Schafer M, Suter C, Klaiber C, Wehrli H, Frei E, Krahenbuhl L. Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc. 1998. 12:305–309.
2. Rice DC, Memon MA, Jamison RL, Agnessi T, Ilstrup D, Bannon MB, et al. Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg. 1997. 1:85–91.
3. Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL. Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. Postgrad Med J. 2004. 80:77–79.
4. Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg. 2007. 193:73–78.
5. Papasavas PK, Caushaj PF, Gagne DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2002. 12:383–386.
6. Hawasli A, Schroder D, Rizzo J, Thusay M, Takach TJ, Thao U, et al. Remote complications of spilled gallstones during laparoscopic cholecystectomy: causes, prevention, and management. J Laparoendosc Adv Surg Tech A. 2002. 12:123–128.
7. Hand AA, Self ML, Dunn E. Abdominal wall abscess formation two years after laparoscopic cholecystectomy. JSLS. 2006. 10:105–107.
8. Tumer AR, Yuksek YN, Yasti AC, Gozalan U, Kama NA. Dropped gallstones during laparoscopic cholecystectomy: the consequences. World J Surg. 2005. 29:437–440.
9. Albrecht RM, Eghtestad B, Gibel L, Locken J, Champlin A. Percutaneous removal of spilled gallstones in a subhepatic abscess. Am Surg. 2002. 68:193–195.
10. Trerotola SO, Lillemoe KD, Malloy PC, Osterman FA Jr. Percutaneous removal of "dropped" gallstones after laparoscopic cholecystectomy. Radiology. 1993. 188:419–421.