Spilled Gallstones Silent for a Decade: A Case Report and Review of Literature

Abstract

Laparoscopic cholecystectomy is associated with complications such as gallbladder perforation and spillage of gallstones. While these shortcomings are common, the occurrence of the resultant nuisances, such as intra-abdominal abscesses, is infrequent. We present the case of an individual who developed an intra-abdominal abscess following a spillage of gallstones, which occurred after a laparoscopic cholecystectomy that was performed more than a decade ago. Herein, we also discuss the findings of a literature review that highlights the clinical presentations of an intra-abdominal abscess formed due to gallstone spillage after a decade of the laparoscopic intervention. We also discuss the underlying pathophysiology leading to abscess formation, the imaging modalities used to visualize the abscess, as well as the therapeutic strategy used to treat this rare clinical entity.

A case report: Delayed gallstone abscess formation 10 years post-cholecystectomy

“…In high-risk situations, it is essential for surgeons to be vigilant for gallbladder perforation and gallstone spillage. If there are spilled gallstones, it is recommended to do preventative measures for infection by irrigation with saline to dilute bile contents and retrieve all stones [ 9 ]. Previous studies do not support switching to open surgery as it increases patient morbidity [ 10 ].…”

Practices and Attitudes of Surgeons With Regard to Spilled Gallstones During Laparoscopic Cholecystectomy: A Cross-Sectional Study From Saudi Arabia

“…In a similar study conducted by Yethadka et al in 2014, 76.8% of the participants thought that two years were sufficient to follow up after spilled stones and that they had no knowledge about the possibility of delayed complications [4]. In the literature, complications from unretrieved gallstones have been described as occurring years or even decades later [15][16][17]. Morris et al reported a 71 year-old-female who presented with complete bowel obstruction 15 years after LC [18].…”

Elderly man with abdominal and chest pain

“…In our case, bedside ultrasound not only allowed for rapid diagnosis of the pseudoaneurysm, but also allowed for identification of the associated perihepatic abscess, diaphragmatic disruption, and communicating right pleural effusion with empyema. These are also rare complications of laparoscopic cholecystectomy that have often been associated with spilled and retained gallstones 4 …”