Cholelithoptysis and pleural empyema.
We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy.
Department of Surgery, University of Ottawa, and Montfort Hospital, Ontario, Canada.
P
P
Chopra
P
P
Killorn
R J
RJ
Mehran
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis; D003371:Cough; D016724:Empyema, Pleural / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000209:etiology; D016156:Respiratory Tract Fistula / Q000209:etiology; D013369:Subphrenic Abscess / Q000209:etiology