Thoracic Gallstones: A Delayed Complication of Laparoscopic Cholecystectomy

Quail, Jacob; SoballePeter, W; GraminsDaniel, L

doi:10.1089/sur.2012.218

Cited by 17 publications

(14 citation statements)

References 9 publications

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“…Both cholelithoptysis and lumbar/flank abscesses have been noted in individual previous cases, but not with a combined presentation, as with this unfortunate patient 7 9…”

Section: Discussionmentioning

confidence: 55%

Back to the gallstone: a mischievous cause of morbidity

Heron¹,

Manzelli

2016

BMJ Case Reports

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Laparoscopic cholecystectomies (LCs) are the gold standard treatment of symptomatic gallstone disease worldwide. However, with this technique comes the increased risk of retained spilled gallstones. We describe a case of a 77-year-old man who presented 2 months after undergoing a LC, with right upper quadrant pain. Abdominal ultrasound scan showed no significant complications, but he continued to have grumbling pains. These were investigated with an abdominal CT scan, prompting suspicion of a colorectal malignancy with pleural metastasis. However, on review by two different multidisciplinary teams, the final conclusion was probable residual gallstones with associated inflammation. This diagnosis was rather dramatically confirmed when the patient went on to expel gallstones percutaneously from his back and coughed out of his respiratory tract. This case highlights the importance of operative documentation of spilled gallstones, which can, in addition to more surprising consequences, mimic malignancy on investigation. This can lead to delay in correct management and cause undue patient distress.

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“…Both cholelithoptysis and lumbar/flank abscesses have been noted in individual previous cases, but not with a combined presentation, as with this unfortunate patient 7 9…”

Section: Discussionmentioning

confidence: 55%

Back to the gallstone: a mischievous cause of morbidity

Heron¹,

Manzelli

2016

BMJ Case Reports

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“…Gallstone spillage is more common in laparoscopic cholecystectomy than in open cholecystectomy. Additionally, it is more difficult to retrieve the stones with the laparoscopic approach and so stones are retained in the peritoneal cavity in 13%-32% of laparosocopic cholecystectomies [3]. Complications of retained stones are uncommon (0.1%-0.3% of cases) but significant [5,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently reported complications are intraperitoneal and abdominal wall abscesses. Other complications in the literature include intestinal obstruction, colocutaneous fistula, pleural empyema, broncholithiasis, sinus formation, bladder fistulisation, incarcerated hernia and dyspareunia [1,3,4,9]. The temporal course to spilled gallstone complications has been reported from one month to twenty years; however most commonly occur at approximately four months postoperatively [1,3,4].…”

Section: Discussionmentioning

confidence: 99%

“…The advantages include decreased hospital stay, decreased post-operative pain, speedier recovery and improved cosmesis. However, perforation of the gallbladder and spillage of gallstones during laparoscopic cholecystectomy is more common than in open cholecystectomy and occurs in 8%-40% of cases [1][2][3][4]. Spilled stones can cause rare but serious complications including both intra and extraperitoneal abscesses, fistula formation, intestinal obstruction, pleural effusion and broncholithiasis [3,5].…”

Section: Introductionmentioning

confidence: 99%

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Flank Abscess: A Complication of Spilled Gallstones

Sandstrom¹,

Clarson²

2015

JCR

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Spilled unretrieved gallstones can cause rare but significant complications such as intraperitoneal abscesses, fistulas, intestinal obstruction and broncholithiasis. A 79 year old woman presented with a painful abscess on her right flank and MRI that revealed a large collection extending into the pararenal space. Her recent surgical history included a laparoscopic cholecystectomy for cholecystitis. She underwent an incision and drainage of the flank abscess which revealed a large cavity containing purulent exudate and several small gallstones. Gallstones are more likely to be spilled during laparoscopic cholecystectomy when compared to the open procedure. Steps during a laparoscopic cholecystectomy where the gallbladder can be perforated include when grasping the gallbladder, when dissecting the gallbladder off the liver and during retrieval through the umbilical port site. The risk of perforation is increased with an inflamed gallbladder. Spilled gallstones can have serious complications that will likely require an additional surgical procedure.

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“…Intra-thoracic migration of spilled gallstones is a rare complication. It is thought to result from a subphrenic abscess that leads to a fistulous tract through the diaphragm into the pleural cavity [2].…”

mentioning

confidence: 99%