False Alarm: When Dropped Gallstones Mimic Malignant Recurrence. A Case Report and Literature Review

Dropped gallstones are a known complication of laparoscopic cholecystectomy, occurring in up to 40% of cases. While often considered benign, they can lead to complications like abscess formation and peritoneal adhesions. In cancer patients, dropped gallstones may mimic disease recurrence, leading to unnecessary diagnostic procedures and patient distress. We report the case of a 63-year-old woman with a history of leiomyosarcoma, previously treated with surgical resection. She subsequently underwent laparoscopic cholecystectomy for acute cholecystitis. Ten months later, she presented with nonspecific upper abdominal symptoms, and imaging indicated peritoneal nodularity suspicious for malignancy. A CT-guided biopsy was inconclusive, prompting diagnostic laparoscopy revealing multiple dropped gallstones with granulomatous inflammation but no evidence of malignancy. The patient remained symptoms free after retrieval, with no further radiological abnormalities on follow-up imaging. This case highlights the diagnostic challenges posed by dropped gallstones, particularly in oncology patients where they can be mistaken for peritoneal metastases. Surgeons should be meticulous to retrieve all gallstones during laparoscopic cholecystectomy, and radiologists should include dropped gallstones in the differential diagnosis of new intra-abdominal lesions in postsurgical patients. Awareness of this phenomenon can prevent unnecessary interventions and patient anxiety.