Gallstone-Related Abdominal Abscess 8 Years After Laparoscopic Cholecystectomy

Abstract

An unusual collection of fluid in the perihepatic space needs to be investigated for abscess in patients with a remote history of cholecystectomy.

Dropped Gallstones Causing a Perihepatic Abscess and Empyema

“…Laparoscopically, surgeons may attempt extraction of dropped stones; however, stones may become fragmented, inaccessible, or overlooked, leaving gallstones within the intraperitoneal cavity. There is a reported incidence of gallbladder perforation of 10–40% [ 2 – 5 ]. In a retrospective study of 3686 patients who underwent laparoscopic cholecystectomy, gallstone spillage occurred in 254 patients or 6.9% [ 3 ].…”

An unsuspected cause of abdominal pain and fever: lost gallstone‐related perisplenic abscess

“…2 Intra- [1][2][3][4][5]12 Usually, complete drainage and stone removal are achieved by open surgery; 1,2,5 but laparoscopy should be taken into consideration when it is technically possible, given the well-known advantages associated with a minimally invasive procedure. 2,14 The present case, albeit uncommon, should take into consideration to include intra-abdominal or even intra-thoracic abscesses due to spilled gallstones in the differential diagnosis of any chronic pain or fever of unknown origin in patients with a history of laparoscopic cholecystectomy. 1,3,4,6 Due to its relative rarity, diagnosis can be challenging but prompt identification is crucial for appropriate management of the disease, given that such a condition might represent surgical emergency leading to severe sepsis if left untreated.…”

“…Intra‐abdominal abscesses require antibiotic therapy, drainage or surgical removal, or both, if stones are present . Usually, complete drainage and stone removal are achieved by open surgery; but laparoscopy should be taken into consideration when it is technically possible, given the well‐known advantages associated with a minimally invasive procedure …”

Unusual aetiology of abdominal wall abscess: cholecystocutaneous fistula presenting 20 years after open subtotal cholecystectomy

“…This can happen many years after surgery, for example, in the case of a patient who presented with painful defecation due to an abscess in the pouch of Douglas, and was also found to have a small asymptomatic chronic anterior abdominal wall abscess 10. Gallstones have also been reported to lodge in the anterior abdominal wall during port removal after laparoscopic cholecystectomy—either at the level of the rectus sheath or internal oblique muscle—and to cause abscess formation up to 8 years after operation 11 12…”