Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report

Abstract

One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient's decision to refuse abscess's surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

Flank Abscess: A Complication of Spilled Gallstones

“…The most frequently reported complications are intraperitoneal and abdominal wall abscesses. Other complications in the literature include intestinal obstruction, colocutaneous fistula, pleural empyema, broncholithiasis, sinus formation, bladder fistulisation, incarcerated hernia and dyspareunia [1,3,4,9]. The temporal course to spilled gallstone complications has been reported from one month to twenty years; however most commonly occur at approximately four months postoperatively [1,3,4].…”

“…It can occur during gasping and traction of the gallbladder, during dissection of the gallbladder from the liver bed, and during retrieval of the dissected gallbladder through the umbilical port site. The Hartmann's pouch clip can also become dislodged [3,4]. The risk of gallbladder perforation is increased with an inflamed, friable gallbladder wall and with difficult dissection due to adhesions [10].…”

“…The treatment of spilled gallstones is ultimately to remove the stones and to treat any complications [5,10]. Several cases in the literature reported the need for bronchoscopy to retrieve a broncholithiasis and in one extreme case, a wedge resection of the lung was performed for a chronic abscess caused by a gallstone [4,6].…”

“…The advantages include decreased hospital stay, decreased post-operative pain, speedier recovery and improved cosmesis. However, perforation of the gallbladder and spillage of gallstones during laparoscopic cholecystectomy is more common than in open cholecystectomy and occurs in 8%-40% of cases [1][2][3][4]. Spilled stones can cause rare but serious complications including both intra and extraperitoneal abscesses, fistula formation, intestinal obstruction, pleural effusion and broncholithiasis [3,5].…”

Removal of gallstone from mesorectum after laparoscopic cholecystectomy - new indication for transanal endoscopic microsurgery technique.

“…The most common complications are intra- and retroperitoneal abscesses, external fistulas and fistulas communicating with internal organs (small intestine, colon and urinary tract) [ 21 – 23 ]. In the literature there were several cases described where gallstones translocated through the diaphragm into the chest cavity or into the groin hernia sac [ 24 , 25 ].…”