Intra-abdominal spilled gallstones simulating peritoneal metastasis: CT and MR imaging features (2008: 1b)

Abstract

Laparoscopic cholecystectomy has rapidly become the preferred treatment for symptomatic cholecystolithiasis. However, the procedure is associated with a number of complications, one of which is the spillage of gallstones into the peritoneal cavity. Unretrieved gallstones may cause a wide variety of complications such as abscess, adhesion and small-bowel obstruction, or they may remain asymptomatic and harmless. In the latter case, spilled gallstones in the peritoneal spaces may cause diagnostic difficulty or mimic peritoneal metastasis. We present the computed tomography (CT) and magnetic resonance (MR) imaging features of intra-abdominal gallstone spillage in a case with head and neck neoplasm. Awareness of radiologic features of dropped intraperitoneal gallstones is necessary as they may be mistaken for peritoneal metastases.

Consequences of Spilt Gallstones During Laparoscopic Cholecystectomy

“…Some of these complications are not so significant, while some others are very significant which include abscess in the abdominal wall, broncholithiasis, stone expectoration, cellulites, dyspareunia, erosion to the back, fat necrosis posterior of the rectus muscle, fever, fistula formation, gallstone granuloma, gluteal abscess, granulomatous peritonitis mimicking endometriosis, ileus, intestinal obstruction, implantation malignancy, incarcerated hernia, intra-abdominal abscess, jaundice, liver abscess mimicking malignancy, middle colic artery thrombosis, mimicking acute appendicitis, paracolic abscess, paraumbilical tumor, peritoneal abscess formation, pelvic abscess, pelvic stones, peritonitis, pleural empyema, fluid collections, pneumonia, port site stones, port site abscess, recurrent staphylococcal bacteremia, retrohepatic abscess, retroperitoneal abscess, retroperitoneal actinomycosis, right flank abscess, small bowel obstruction, stones in gastrocolic omentum, stones in hernia sac, stones of the ovary, stone of the fallopian tube, subhepatic abscess, subphrenic abscess, thoracoabdominal mycosis, trans diaphragmatic abscess, umbilical wound abscess, and vesical granuloma [3,4,[9][10][11][12][13][14][15][16].…”

Fail to Retrieve Gallstones in Laparoscopic Cholecystectomy- A Study

“…[5] The reason for our incidence being higher is likely to be the policy of taking on all gallbladder disease irrespective to the state of acuteness and friability of the gallbladder. The reported incidence of unretrieved [20,21,22] gallstones is 0% in our series, while an attempt was made to take out all the spilt stones [23] diligently. It is difficult to claim no stones were left behind.…”

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

“…On MR, pigmented DGs may appear as hyperintense on T 1 weighted images, whereas other stones are hypointense on both T 1 and T 2 weighted images (Figure 2b) Lack of contrast enhancement is useful for making the correct diagnosis [1,3,4].…”

“…Corresponding ultrasound demonstrates a hypoechoic fluid collection containing hyperechoic foci with posterior shadowing (Figure 3c). MRI shows a perihepatic fluid collection with foci of low T 2 signal (corresponding to the DGs) (Figure 3d) [3,4]. Recognising the DG within the abscess in any of these modalities is crucial because, unlike other abdominal abscesses, which are treated with antibiotics and/or percutaneous drainage, the definitive treatment for an abscess associated with a DG requires removal of retained gallstones [1].…”

“…DGs around the liver may be confused with peritoneal metastatic implants or lymph nodes, having a similar appearance of round soft-tissue perihepatic nodules with a high attenuation peripheral rim on CT (Figures 7 and 8) [3]. Unenhanced CT may be useful in elucidating the calcified nature of these nodules.…”