Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls

Abstract

Spillage of gallstones into the abdominal cavity, referred to as "dropped gallstones" (DGs), occurs commonly during laparoscopic cholecystectomy. The majority of these spilled stones remain clinically silent; however, if uncomplicated DGs are not correctly identified on subsequent imaging, they may mimic peritoneal implants and cause unduly concern. A small percentage of DGs cause complications, including abscess and fistula formation. Recognising the DG within the abscess is critical for definitive treatment. This pictorial review illustrates the imaging appearances and complications of DGs on CT, MRI and ultrasound and emphasises pitfalls in diagnosis.Laparoscopic cholecystectomy (LC) is the procedure of choice for routine gallbladder removal and is the most common major abdominal procedure performed in Western countries [1]. The use of laparoscopic technique has resulted in an increased incidence of spillage of stones into the intraperitoneal space (;30%) owing to perforation of the gallbladder during cholecystectomy [1,2]. Spilled gallstones, "dropped gallstones" (DGs), were initially considered to be harmless; however, it is now well recognized that DGs can result in complications, mainly abscess and fistula formation [2]. The purpose of this essay is to illustrate the spectrum of CT, sonographic and MRI findings of DGs, describe associated complications, and present diagnostic mimics and pitfalls.

Chronic right lumbar suppuration following stone forgotten during laparoscopic cholecystectomy

“…They are often found incidentally during practice of standard Xrays or scanners for other reasons. 5,6 The rate of abdominal complications reported after removal of calculi in intra peritoneal is estimated at 1.4% according to a Swiss retrospective analysis. 7 These complications include abscesses in the abdominal wall, sub-phrenic abscess and sub-hepatic fistula, dehiscence, hernia and tumors containing calculi.…”

Hallazgos imagenológicos en cálculos abandonados en cavidad abdominal posterior a colecistectomía por laparoscopia: serie de 7 casos y revisión de la literatura

“…Es conocido que todos los cálculos, independientemente de la presencia de calcio, causan este artificio en el ultrasonido (2,3,25) (Figura 4). Solo hay unas pocas series de casos que describen las características imagenológicas en la TC de los cálculos abandonados luego de colecistectomía, tales como lesiones heterogéneas hipodensas, con o sin calcificación central, y realce periférico luego de la administración de contraste.…”

Laparoscopic drainage of sub phrenic abscess

“…The cavity eventually gets walled off from the rest of the peritoneal cavity. [2][3][4] This also exerts an effect on the respiratory excursions of the right hemi-diaphragm which cause complications of the lower lobe of lung usually accompanied with a sympathetic pleural effusion. Sepsis can make the situation worst as the patient can develop frank septicaemia.…”

“…A contrast enhanced CT scan of the abdomen is the best investigation to identify the exact location, size and the presence of any dropped gall stones especially in cases following laparoscopic cholecystectomy. 2,4 Hence timely diagnosis is of utmost importance. Prompt surgical intervention is the mainstay of treatment.…”

“…Patient had undergone laparoscopic cholecystectomy one week back which was uneventful. 2 Patient was passing flatus and stools normally with no other symptoms. However, on the 10 th day after surgery, patient started complaining of severe pain in the right hypochondrium extending to the posterolateral aspect of the right hemi thorax.…”