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.
Chopra
P
P
Department of Surgery, University of Ottawa, and Montfort Hospital, Ontario, Canada.
Killorn
P
P
Mehran
R J
RJ
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