Vinayak Sreenivas, MD, Vinay Singhal, MD, Amir R Azar, MD, Daniel Farkas, MD. Bronx Lebanon Medical Centre
Approximately one third of laparoscopic cholecystectomies are reported to have dropped or lost gallstones during dissection. Complications like infection, inflammation, fibrosis, adhesion, cutaneous sinus formation, and abscesses; though uncommon, can be dangerous. Surgeons and radiologists should be aware of these complications and the related morbidity. We present a case of intra-peritoneal abscess with subcutaneous extension caused by dropped stones during laparoscopic cholecystectomy.
A 75yr old lady who had undergone laparoscopic cholecystectomy ten months prior presented to the emergency room with fever, nausea, vomiting and abdominal mass. She had a similar abscess drained percutaneously 6 months after surgery. She was diagnosed following CT scan of the abdomen with intraperitoneal abscess with subcutaneous extension. Two radio-opaque foreign bodies, possibly dropped stones, were observed in the right sub-diaphragmatic recess. Patient underwent open drainage of the abscess with retrieval of stones.
There are several reports of spilled gallstones causing abscess and a few causing abdominal wall abscess including port site abscess after ‘dropped’ gallstones. Open drainage and retrieval of stones instead of just draining the abscess percutaneously avoids recurrence and attendant morbidity. Also, considerable care should be taken to retrieve spilled gallstones and avoid gallbladder perforation.
Session Number: Poster – Poster Presentations
Program Number: P367