Dropped Gallstones and Surgical Clips After Cholecystectomy

Abstract

Subhepatic location was the most common location for dropped gallstones with associated abscess and for dropped surgical clips. Dropped cholecystectomy clips are not associated with increased risk of abscess formation and therefore do not need screening follow-up or operative removal. Abscess formation around dropped gallstone is a more common complication and requires surgical treatment in most when associated with an abscess.

Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls

“…On MR, pigmented DGs may appear as hyperintense on T 1 weighted images, whereas other stones are hypointense on both T 1 and T 2 weighted images (Figure 2b) Lack of contrast enhancement is useful for making the correct diagnosis [1,3,4].…”

“…The most common complication of DGs is the formation of an abscess around the DG, which is presumably the source of infection [1].…”

“…Contrast-enhanced CT demonstrates a perihepatic, complex multiloculated fluid collection (Figures 3-5). If the DG is densely calcified, it will appear as a high-attenuation focus within the collection, rendering the correct diagnosis straightforward (Figure 3b) [1,4]. However, when the DG within the abscess is very small or non-calcified, it may easily be overlooked, accounting for failure to associate the abscess with a DG (Figures 4 and 5).…”

“…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].…”

“…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].…”