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Year : 2001  |  Volume : 11  |  Issue : 2  |  Page : 81-82
Case report : Dropped calculus post laparoscopic cholecystectomy


Department of Radiodiagnosis, KMC, Mangalore, India

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Keywords: Dropped calculus, complication, post-laparoscopy, cholecystectomy

How to cite this article:
Mahale A, Hegde V, Shetty R, Venugopal A, Kumar A. Case report : Dropped calculus post laparoscopic cholecystectomy. Indian J Radiol Imaging 2001;11:81-2

How to cite this URL:
Mahale A, Hegde V, Shetty R, Venugopal A, Kumar A. Case report : Dropped calculus post laparoscopic cholecystectomy. Indian J Radiol Imaging [serial online] 2001 [cited 2019 Dec 9];11:81-2. Available from: http://www.ijri.org/text.asp?2001/11/2/81/28379

   Case Report Top


A fifty-five-years old man presented to our hospital with symptoms of pain and abdominal distention. He had undergone laparoscopic cholecystectomy about a year ago. On examination he was found to have hepatosplenomegaly with ascites. Further investigation with ultrasound revealed ascites, portosystemic collaterals and hepatosplenomegaly. He further developed pulmonary symptoms for which a CT scan was performed. The lower sections through the upper abdomen revealed post-cholecystectomy clips, which were seen as hyperdense foci in the gall bladder fossa. There was a small hyperdense focus seen along the posteroinferior aspect of the liver capsule, which showed a higher density (365HU) compared to the cholecystectomy clips (165HU). It was seen to be surrounded by a hypodense collection, which was due to ascites around the liver. Our diagnosis suggested a post-laparoscopic cholecystectomy dropped calculus.


   Discussion Top


Laparoscopic cholecystectomy is one of the major therapeutic innovations for treatment of cholecystolithiasis, the others being bile salt dissolution and extracorporeal shock wave lithotripsy [1].

The major complications of the procedure are biliary injury, wound infection, bowel and vascular injury and spillage of stones which occur in about 10% of patients [1].

Leaving the stones in the peritoneal cavity may result in intra-abdominal abscess, subcutaneous abscess and later discharge of stones through the abdominal wall or biliary tract [1].

Dropped stones or stone fragments can lodge in virtually any crevice of the abdominal cavity. The combination of pneumoperitoneum and peritoneal irrigation performed at the time of laparoscopic cholecystectomy may disperse calculi in the peritoneal cavity. Stones can also migrate into the right pleural space. Sometimes they may erode into the wall of the transverse colon [2].

Cross sectional imaging techniques (US, CT and MR) may show the presence of gallstones. Complications including abscess formation are related to spillage of infected stones and bile [1].

Infections are more likely with bilirubinate stones because stones contain viable bacteria [3].

The site of eventual abscess formation may be unusual and the delay between laparoscopic cholecystectomy and abscess presentation is often considerable [4].

The mean duration from dropped stones to the correct diagnosis is often almost three years [1]. The formed abscess may be diagnosed as simple abscesses if stones are non-opaque [1].

Gallstones that migrate into the thorax may result in pleurolithiasis, cholelithoptysis and broncholithiasis [5]. The mainstay in prevention is avoidance of gall bladder perforation by improved instrumentation and technique.

If stone spillage occurs, cross-sectional imaging techniques can be used for early identification of dropped stones before abscess formation. We found that US supplemented by CT, if required should suffice to diagnose post-laparoscopic cholecystectomy.

 
   References Top

1.Stasberg SM. Laparoscopic biliary surgery. Gastroenterol Clin North Am 1999; 28:117:32  Back to cited text no. 1    
2.Morrin MM et al. Radiologic features of complications arising from dropped gall stones in Laparoscopic Cholecystectomy patients. AJR 2000; 174:1441-1445  Back to cited text no. 2    
3.Stewart L et .al. Pigment Gall stones form a composite of bacterial microcolonies and pigment solids. Ann Surg 1987; 2063:242-250.  Back to cited text no. 3    
4.Horton M, Florence MG. Unusual abscess pattern following dropped gallstones during laparoscopic cholecystectomy. Am J Surgery 1998; 175:375-379.   Back to cited text no. 4    
5.Lardeo J et.al. A seventy year old man with an empyema. Lancet 1998; 352:1982.  Back to cited text no. 5    

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Correspondence Address:
A Mahale
Department of Radiodiagnosis, KMC Light House Hill, Mangalore 575 001
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2]

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1 Gallstone abscess as a result of dropped gallstones during laparoscopic cholecystectomy
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2 Gallstone abscess: A delayed complication of spilled gallstone after laparoscopic cholecystectomy
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