Recurrence of Citrobacter koseri-associated intra-abdominal infection 2 years after spilled gallstones during laparoscopic cholecystectomy

Introduction Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. Methods Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. Results Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. Conclusions Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.

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Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review

Gavriilidis

Catena

de’Angelis

et al. 2022

World J Emerg Surg

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Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication—case report and review of the literature

Danhel,

Fritz,

Havranek

et al. 2024

Front. Surg.

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IntroductionLaparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC.MethodsCase report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022.Case ReportAn 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation.ConclusionIntraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.

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Delayed Post-cholecystectomy Gallbladder Fossa Abscess Due to Citrobacter freundii

Malhotra¹,

Lara‐Reyna²,

Harvey³

et al. 2023

Cureus

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While laparoscopic cholecystectomy has become the treatment of choice for cholecystitis, complications such as abscess development can result even years after the intervention. We present a case of a patient with a remote history of laparoscopic cholecystectomy now diagnosed with gallbladder fossa abscess infected with Citrobacter freundii, a low-virulence pathogen typically seen in iatrogenic urinary tract infections. Subsequent conjoint percutaneous drainage and long-term antibiotics resulted in both clinical and radiological improvement for the patient. Therefore, in the absence of recent events or risk factors for developing an abdominal wall abscess, a previous remote history of surgical intervention needs to be considered for the possible etiology, especially those with low incidences and long latency periods such as Citrobacter.

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Recurrence of Citrobacter koseri-associated intra-abdominal infection 2 years after spilled gallstones during laparoscopic cholecystectomy

Cited by 3 publications

References 7 publications

Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review

Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review

Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication—case report and review of the literature

Delayed Post-cholecystectomy Gallbladder Fossa Abscess Due to Citrobacter freundii

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