Recurrent right flank abscess as a manifestation of retained gallstone and novel technique of retrieval using CT guided needle as marker.

Manthan Makadia, MD1, Dhruv Patel2, Stanley Ogu, MD1, Aniket Sakharpe, MD1, Abdul Badr, MD1. 1Easton Hospital, 2Drexel University

Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for the past 15 years, however the incidence of complications from lost gallstones has not changed significantly despite the advanced experience of general surgeons. During laparoscopic cholecystectomy, the gallbladder can perforate upon detachment from the liver or during its retrieval through the trocar site in up to 40% of cases. Gallstones can be dropped into the peritoneal cavity around the liver, within the abdominal wall, or between small intestines in up to 30% of cases. In roughly 0.5-6% of LC cases, the gallstones left behind can lead to complications. These complications have been shown to cause inflammation, abscesses, peritonitis and even adhesions, inflammatory reactions, abscesses or peritonitis. We present a case of a 75-year-old male who was admitted with recurrent right flank abscess with draining sinus one year following laparoscopic cholecystectomy. Computerized tomography (CT) scan evaluation showed displaced gallstones in Morrison’s pouch. Hereby we describe the novel approach of CT-guided needle placement and subsequent exploration of the patient’s 10th and 11th rib interspace with extraction of two displaced gallstones in the subhepatic region with adjacent inflammatory process.

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