Dropped Gallstones Causing a Perihepatic Abscess and Empyema

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Surgical Complications

Background:

• Iatrogenic gallbladder perforation during laparoscopic cholecystectomy is known.
• Consequences of dropped gallstones, especially intrathoracic complications, are less defined.

Purpose of the Study:

• To describe a case of delayed perihepatic abscess and empyema secondary to dropped gallstones.
• To highlight the potential for long-term complications from retained gallstones after laparoscopic cholecystectomy.

Main Methods:

• Case report of a 53-year-old male presenting with symptoms of infection five years post-laparoscopic cholecystectomy.
• Diagnostic imaging including Computed Tomography (CT) scan.
• Open intra-abdominal exploration for diagnosis and retrieval of gallstones.

Main Results:

• Patient presented with cough, hemoptysis, night sweats, and RUQ pain.
• CT scan revealed subpulmonic and perihepatic fluid collections with a radiopaque density.
• A 1 cm intraperitoneal gallstone was retrieved during surgery.

Conclusions:

• Gallstone spillage during laparoscopic cholecystectomy can lead to delayed intra-abdominal and intrathoracic complications.
• These complications can manifest years after the initial surgery.
• Efforts to retrieve all spilled gallstones during the index operation are essential to prevent future morbidity.