Article

Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview.

Journal of Medical Case Reports 01/2009; 3:8626. DOI: 10.4076/1752-1947-3-8626
Source: PubMed

ABSTRACT Gallbladder perforation is common and occurs in 6 to 40% of laparoscopic cholecystectomy procedures. In up to a third of these cases, stones are not retrieved and complications can arise many years post-operatively. Diagnosis can be difficult and patients may present to many specialties within medicine and surgery. We seek to present our case and review the literature on prevention and management of "lost" stones.
Our patient is a 77-year-old woman who presented to the urology clinic with a loin abscess that developed five years after laparoscopic cholecystectomy. Radiological studies showed retained abdominal gallstones and an associated abscess formation. These were drained under ultrasound guidance on several occasions and the patient now suffers from chronic sinusitis. Due to her age and comorbidities, she has declined definitive surgical intervention to remove the stones.
Gallbladder perforation during laparoscopic cholecystectomy is a reasonably common problem and may result in spilled and lost gallstones. Though uncommon, these stones may lead to early or late complications, which can be a diagnostic challenge and cause significant morbidity to the patient. Clear documentation and patient awareness of lost gallstones is of utmost importance, as this may enable prompt recognition and treatment of any complications.

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    ABSTRACT: Gall bladder perforation, gallstone spillage and loss are commonly reported from Laparoscopic Cholecystectomy (LC). Though rare, lost gallstones can cause a variety of complications presenting variably from within 1 month to 20 years postoperatively. Our objective was to investigate knowledge and practices of surgeons and surgical residents regarding spilled gallstones lost during laparoscopic cholecystectomy. An observational, cross-sectional survey, using a questionnaire based on 13 self-answered close-ended questions, was conducted at 6 different post-graduate centers in Karachi, Pakistan RESULTS: Of the 82 participants, 23 (28%) were consultant surgeons while 59 (72%) were general surgery residents. 86% of participants were aware that stones lost during LC can cause complications. Out of the 18 reported complications presented, only 20% participants identified more than 8 complications for which they can consider lost gallstones causal. 28% of participants weren't aware about the expected postoperative duration for presentation of complications. Only 15% of our participants expected complications beyond 5 years of the procedure. 72% of participants will not convert to open cholecystectomy to retrieve lost gallstones. While 88% of participants agreed that lost gallstones should be documented in operative notes, only 70% reported that it's actually done in practice. 55% of participants agreed to have possibility of lost gallstones as part of the informed consent but in practice it's included according to only 31% of participants. 68% of participants believe that patients should be informed if gallstones are lost but in actual practice only 41% participants inform patients when gallstones are lost during procedure. We conclude that there is a dearth of awareness regarding diversity of complications from lost gallstones and about their variable postoperative duration of presentation. The practices involving lost gallstones management, documentation and patient information were found to vary widely. Proper awareness is imperative as it may compel surgeons to undertake all possible measures to retrieve spilled gallstones and progress towards better and standardized practices in managing lost gallstones.
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    ABSTRACT: 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. 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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