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Spilled gallstones after laparoscopic cholecystectomy
Pavlos K Papasavas1, Philip F Caushaj, Daniel J Gagné
1Temple University Clinical Campus at The Western Pennsylvania Hospital, Department of Surgery, Pittsburgh, Pennsylvania 15224, USA. ppapasav@wpahs.org
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|December 10, 2002
Summary
Spilled gallstones during laparoscopic cholecystectomy can cause serious abscesses. Prompt retrieval of spilled gallstones is crucial to prevent complications like flank abscesses.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Laparoscopic cholecystectomy is a common procedure for gallstones.
- Gallstone spillage during surgery presents a unique challenge.
- Retained gallstones can lead to significant post-operative morbidity.
Observation:
- A 77-year-old woman developed a right flank abscess after laparoscopic cholecystectomy with gallbladder perforation and gallstone spillage.
- Initial percutaneous drainage failed, necessitating open drainage.
- Open drainage revealed retained gallstones in the flank, leading to abscess resolution but persistent drainage.
Findings:
- A literature review identified 127 cases of spilled gallstones.
- Intraperitoneal abscesses were the most common presentation (44.1%).
- Other presentations included abdominal wall (18.1%), thoracic (11.8%), and retroperitoneal (10.2%) abscesses.
Implications:
- Gallstone spillage during laparoscopic cholecystectomy requires meticulous management.
- Complete retrieval of spilled gallstones is essential to prevent abscess formation.
- Early recognition and intervention for retained gallstones can improve patient outcomes.