Spilt gallstones removed after one year through a colpotomy incision: report of a case.
Several reports have suggested that gallstones that escape during laparoscopic cholecystectomy may lead to serious intraperitoneal complications, including adhesions, formation of abscesses, and spontaneous hepatic hemorrhage. While gallstone spillage is infrequently reported, the true incidence of spilt stones and surgical morbidity associated with loose stones is unknown. A 42-year-old female patient underwent transvaginal hysterectomy for severe metrorrhagia and dysmenorrhea. On entering the posterior culde-sac through a colpotomy incision, 16 gallstones were discovered in the pouch of Douglas. This patient underwent laparoscopic cholecystectomy 13 months previously for symptomatic cholelithiasis. Review of the literature reveals spilt stones should be removed whenever spillage occurs during surgery. While this patient showed no untoward complications from spilt gallstones of over 1-year duration, removal of all loose stones before terminating the laparoscopic cholecystectomy is highly recommended. Because of a presumed low complication rate, however, most reports do not advocate conversion to an open procedure solely to remove spilled stones.
Wittich
Arthur C
AC
Department of Surgery, DeWitt Army Hospital, Fort Belvoir, VA 22060, USA. www.drwittich@aol.com
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery*; D020884:Colpotomy; D004312:Douglas' Pouch; D005260:Female; D005704:Gallbladder / Q000293:injuries*; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006801:Humans; D007045:Hysterectomy, Vaginal; D012086:Reoperation