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Cholelithoptysis and pleural empyema.

P Chopra1, P Killorn, R J Mehran

  • 1Department of Surgery, University of Ottawa, and Montfort Hospital, Ontario, Canada.

The Annals of Thoracic Surgery
|July 27, 1999
PubMed
Summary

Gallstone spillage during laparoscopic cholecystectomy can lead to delayed complications like cholelithoptysis and pleural empyema. This case highlights the importance of retrieving spilled gallstones to prevent serious, non-operative management scenarios.

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Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Surgical Complications

Background:

  • Laparoscopic cholecystectomy is a common surgical procedure for gallstones.
  • Gallstone spillage during surgery can lead to intra-abdominal abscesses.
  • Delayed presentation of complications is a known risk.

Observation:

  • A patient developed cholelithoptysis (expectoration of gallstones) and pleural empyema.
  • Symptoms arose from a subphrenic abscess with trans-diaphragmatic penetration.
  • A peritoneo-pleuro-bronchial fistula led to spontaneous empyema decompression.

Findings:

  • This is the first reported case of nonoperative management for this specific complication.
  • The patient expectorated bile, gallstones, and pus due to a fistula.

Related Experiment Videos

  • The subphrenic abscess was a precursor to the diaphragmatic penetration.

    • Implications:

    • Emphasizes the critical need for meticulous intraoperative retrieval of spilled gallstones.
    • Highlights the potential for severe, delayed complications following laparoscopic cholecystectomy.
    • Supports conservative management strategies in select cases of complex post-surgical fistulas.