Gallstone abscess: a delayed complication of spilled gallstone after laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the preferred method of treatment of cholelithiasis since its inception in 1987. Although overall complication rate is less than that of traditional approach, two operative complications of laparoscopic cholecystectomy have been frequently described in the literature. One is the bile duct injury or leak and the other one spillage of stones resulting in delayed abscess formation (Horton and Florence, Am J Surg 175:375-379, 1998; Frola et al., BJR 72:201-203, 1999). The incidence of abscess is very rare (approximately 0.3%). The location of the subsequent abscess and the inflammatory masses containing stones or stone fragments is generally in the abdominal wall, subhepatic space, or the retroperitoneum below the subhepatic space but can occur anywhere in the abdomen, right thorax, at trocar site, and at incisional hernia (Zehetner et al., Am J Surg 193:73-78, 2007; Offiah et al., BJR 75:393-394, 2002; Morrin et al., AJR 174:1441-1445, 2000). We report here a case of abscess formation due to spilled stone occurring 6 months post-laparoscopic-cholecystectomy. The diagnosis was suggested by ultrasound examination and was further confirmed by computed tomography scan of the abdomen.