Spillage of gallstones into the abdominal cavity, referred to as "dropped gallstones" (DGs), occurs commonly during laparoscopic cholecystectomy. The majority of these spilled stones remain clinically silent; however, if uncomplicated DGs are not correctly identified on subsequent imaging, they may mimic peritoneal implants and cause unduly concern. A small percentage of DGs cause complications, including abscess and fistula formation. Recognising the DG within the abscess is critical for definitive treatment. This pictorial review illustrates the imaging appearances and complications of DGs on CT, MRI and ultrasound and emphasises pitfalls in diagnosis.Laparoscopic cholecystectomy (LC) is the procedure of choice for routine gallbladder removal and is the most common major abdominal procedure performed in Western countries [1]. The use of laparoscopic technique has resulted in an increased incidence of spillage of stones into the intraperitoneal space (;30%) owing to perforation of the gallbladder during cholecystectomy [1,2]. Spilled gallstones, "dropped gallstones" (DGs), were initially considered to be harmless; however, it is now well recognized that DGs can result in complications, mainly abscess and fistula formation [2]. The purpose of this essay is to illustrate the spectrum of CT, sonographic and MRI findings of DGs, describe associated complications, and present diagnostic mimics and pitfalls.
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