title: Recurrent septic episodes following gallstone spillage at laparoscopic cholecystectomy.
abstract: A 51-year-old woman underwent emergency laparoscopic cholecystectomy. Stone loss occurred during gallbladder dissection. Histology showed empyema of the gallbladder. Postoperatively, she developed a subhepatic abscess that required percutaneous drainage. Two years after surgery, she re-presented with a right paracolic abscess. Transsciatic CT-guided drainage of the abscess was performed. Barium enema excluded colonic pathology. Two weeks later, she developed a right gluteal abscess deep to the recent drain site. Ultrasound-guided drainage was performed followed by a sonogram. The sonogram ruled out communication with the peritoneum. Two further subhepatic abscesses occurred during the next 5 years; the first abscess was drained percutaneously, but the second required open drainage: At laparotomy, gallstone fragments were found within the abscess cavity. The site of the previous gluteal drain continued to discharge intermittently. An MRI scan showed an uncomplicated sinus track. Subsequent sinography of the right gluteal track demonstrated an opacity at the apex of the sinus. The sinus was laid open and a gallstone retrieved. The patient has remained well for 3 years. Complications due to gallstone spillage generally manifest themselves shortly after surgery. This case demonstrates that lost stones may cause chronic abdominal and abdominal wall sepsis. In cases of chronic abdominal sepsis after laparoscopic cholecystectomy, the possibility of lost stones should be considered even if stones are not positively shown on imaging.
authors.affiliation: Leeds Institute for Minimally Invasive Therapy, Leeds General Infirmary, Great George St., Leeds, LS1 3EX, England.
authors.forename: I D
authors.initials: ID
authors.lastname: Botterill
authors.forename: D
authors.initials: D
authors.lastname: Davides
authors.forename: A
authors.initials: A
authors.lastname: Vezakis
authors.forename: M J
authors.initials: MJ
authors.lastname: McMahon
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002769:Cholelithiasis / Q000150:complications*; D005260:Female; D005704:Gallbladder / Q000293:injuries*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D018805:Sepsis / Q000209:etiology*; D014463:Ultrasonography