title: Broncholithiasis and thoracoabdominal actinomycosis from dropped gallstones.
abstract: We report a case of successfully managed invasive, thoracoabdominal actinomycosis caused by the intraperitoneal spillage of gallstones during laparoscopic cholecystectomy. The infected gallstones traversed the diaphragm, migrated into the lung parenchyma, and obstructed a segmental bronchus, causing pneumonia. Treatment involved retrieval of the obstructing stone, debridement and drainage of the pleuroperitoneal phlegmon/abscess, and intravenous antibiotics. The case illustrates the need to remove gallstones at the time of cholecystectomy.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Noda
authors.forename: D I
authors.initials: DI
authors.lastname: Soybel
authors.forename: B A
authors.initials: BA
authors.lastname: Sampson
authors.forename: M M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D000038:Abscess / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D000196:Actinomycosis / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D001982:Bronchial Diseases / Q000209:etiology* / Q000601:surgery; D002137:Calculi / Q000209:etiology* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D003646:Debridement; D003964:Diaphragm; D004322:Drainage; D005260:Female; D005547:Foreign Bodies / Q000601:surgery; D006801:Humans; D007275:Injections, Intravenous; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D010532:Peritoneal Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D010537:Peritoneum; D010995:Pleural Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology; D013896:Thoracic Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery
chemical_list: D010406:Penicillins