Multilocular flank abscess due to stone migration following laparoscopic cholecystectomy with spillage of gallstones.
We report a case of a patient who presented with a large flank abscess 18 months after laparoscopic cholecystectomy. The patient underwent repeated percutaneous drainage but the abscess recurred. Further evaluation with ultrasound revealed subcutaneous tracks from the flank leading to the abdominal cavity and suspected stones in one of the tracks. Laparoscopy revealed dense adhesions at the level of the right gutter leading to a retroperitoneal track heading over to the flank. The tracks were partially opened, debrided, and two gallstones were retrieved from one of the retroperitoneal tracks. The patient's recovery was uneventful. This case demonstrates the potential migration of dropped gallstones to extraperitoneal sites leading to infectious complications. Careful dissection of the gallbladder with an attempt not to rupture it is important in order to prevent this complication. Once rupture does occur, efforts should be made to retrieve dropped stones from the peritoneal cavity. Patients presenting with intra- or extraperitoneal abscesses following laparoscopic cholecystectomy and no obvious source of infection should be evaluated for dropped stones.
Zilbershtein
Sachar
S
Department of Surgery A, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Kessler
Ada
A
Greenberg
Ron
R
Skornick
Yehuda
Y
Avital
Shmuel
S
D018784:Abdominal Abscess / Q000209:etiology* / Q000601:surgery; D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004322:Drainage; D021501:Flank Pain / Q000209:etiology / Q000601:surgery; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000209:etiology* / Q000601:surgery; D012086:Reoperation