Spilled gallstones during laparoscopic cholecystectomy

Area of Science:

• Oncology
• Surgical Pathology
• Hepatopancreatobiliary Surgery

Background:

• Incidental gallbladder cancer is diagnosed in 0.6-2.1% of patients undergoing laparoscopic cholecystectomy.
• Early-stage tumors (Tis or T1a) often require no further intervention.
• Spilled gallstones during surgery can have severe consequences.

Observation:

• A 37-year-old woman with incidental pT1a gallbladder cancer had stones spilled during laparoscopic cholecystectomy.
• Two years post-surgery, she developed recurrent pain and a liver lesion.
• Metastatic gallbladder tumor embedded in gallstones was found on the diaphragm.

Findings:

• Recurrence of early-stage gallbladder cancer can occur due to cell implantation from spilled gallstones.
• The patient's liver lesion was consistent with metastatic gallbladder tumor.
• This highlights the risk associated with spilled stones in incidental gallbladder cancer cases.

Implications:

• Knowledge of spilled stones is vital for managing incidental gallbladder cancer.
• Early and aggressive surgical intervention should be considered for patients with spilled stones.
• This approach may prevent tumor recurrence and metastasis.