Cholelithoptysis and cholelithorrhea: rare complications of laparoscopic cholecystectomy

Laparoscopic cholecystectomy is now considered a safe procedure for the management of cholelithiasis. During the procedure, stone spillage can occur and is usually not considered a serious complication. Clearance of stones can be laborious and is often avoided. Two patients with complications from gross intraperitoneal stone spillage during laparoscopic cholecystectomy, namely cholelithoptysis and cholelithorrhea, are presented. Both patients developed cholelithoptysis, or the coughing up of gallstones, within 1 year of their laparoscopic surgery. In addition, the second patient also experienced the passage of stones from a fistula at the incision site of a remote lumbar laminectomy, which we term cholelithorrhea. We propose that cholelithoptysis developed from the transdiaphragmatic extension of intraperitoneal abscesses and the subsequent formation of bronchopleural fistulas. We believe that gross intraperitoneal stone spillage should be avoided and remedied, if possible, by removal of stones and copious irrigation.