Gallstone-Related Complication 11 Years After Laparoscopic Cholecystectomy: A Report of a Rare Case

Gallbladder perforation during laparoscopic cholecystectomy is relatively common and may result in bile and gallstone spillage. Although most retained gallstones remain clinically silent, they can rarely serve as a nidus for delayed intra-abdominal or abdominal wall abscess formation. We report the case of a 68-year-old man who presented with recurrent fever and persistent right thoracic pain for two months, 11 years after laparoscopic cholecystectomy for acute cholecystitis. Computed tomography revealed a large 15 × 11 cm perihepatic collection located between the liver and intercostal muscles, containing a radiopaque foreign body. A limited open approach was performed through a 3-cm incision over the palpable collection. Purulent material was evacuated, and the foreign body was macroscopically identified as a gallstone. The patient remained asymptomatic at one-month follow-up. Retained gallstones may remain occult for several years and subsequently cause abscess formation in unusual locations. Imaging can provide an important diagnostic clue, particularly when a calcified stone is visible within an abscess. Management depends on the location and depth of the collection and generally requires drainage and removal of the retained stone to achieve definitive source control. A retained spilled gallstone should be considered in the differential diagnosis of a delayed perihepatic or abdominal wall abscess in patients with a history of laparoscopic cholecystectomy. Careful review of imaging and surgical history may facilitate diagnosis, while complete drainage and retrieval of the retained stone can provide definitive treatment.