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[Complications of a lost gallstone]
Dikyi Joyce Ponse1, Martina Heim Classen2, Raphael Jeker3
1Departement Innere Medizin, Kantonsspital Graubünden.
Anamnesis:
An 88-year-old man presented with recurrent fever, weakness, and nausea without emesis for more than four months. Multiple hospital admissions followed, but the reason remained unclear. Eleven years previously, a laparoscopic cholecystectomy had been performed.
Examination:
Routine blood tests revealed leukocytosis and elevated C-reactive protein. A CT-scan of the abdomen revealed a big abscess extending from the intra-abdominal cavity to the subcutaneous tissue near the lumbovertebral column L2 to L5.
Diagnosis:
We postulated an intra-abdominal abscess due to a lost gallstone after laparoscopic cholecystectomy 11 years ago.
Treatment And Follow Up:
The patient underwent surgery and was treated with antibiotics Postoperatively, he suffered from delirium. After prolonged secondary wound healing and antibiotic therapy, the patient was free of infection and could be discharged to his home after rehabilitation.
Conclusion:
Diagnosis was complicated by the clinical presentation, which is often atypical for geriatric patients. Diagnostic delays and recurrent hospitalizations increase the risk of morbidity and mortality. Although the gallstone was never retrieved, another cause of his symptoms was unlikely, as the patient has remained infection-free ever since.
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