Abstract:Highlights
Thoracic complications after spilled gallstones are rare
Thoracic consequences of a spilled gallstone should be considered in every patient with thoracic symptoms and history of cholecystectomy
Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients
Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment
“…However, in our case, cholecystitis was not previously treated with percutaneous transhepatic gallbladder drainage and there was no transthoracic port in laparoscopic cholecystectomy. In the previous reports, the fistula which was caused by abdominal inflammation was identified in the diaphragm [11,20,22]. In contrast, the fistula could not be found in the diaphragm by the visual inspection and palpation in our case.…”
Section: Discussioncontrasting
confidence: 60%
“…Therefore, 76.8% of surgeons have followed up their patients with dropped gallstones two years after LC owing to concerns regarding abdominal infections [9]. The development of pleural empyema after LC has rarely been reported, with only 13 previous cases [10][11][12][13][14][15][16][17][18][19][20][21][22]. The clinical features of pleural empyema, caused by dropped gallstones after LC, are summarized in Table 1.…”
Background
Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC.
Case presentation
We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up.
Conclusions
We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.
“…However, in our case, cholecystitis was not previously treated with percutaneous transhepatic gallbladder drainage and there was no transthoracic port in laparoscopic cholecystectomy. In the previous reports, the fistula which was caused by abdominal inflammation was identified in the diaphragm [11,20,22]. In contrast, the fistula could not be found in the diaphragm by the visual inspection and palpation in our case.…”
Section: Discussioncontrasting
confidence: 60%
“…Therefore, 76.8% of surgeons have followed up their patients with dropped gallstones two years after LC owing to concerns regarding abdominal infections [9]. The development of pleural empyema after LC has rarely been reported, with only 13 previous cases [10][11][12][13][14][15][16][17][18][19][20][21][22]. The clinical features of pleural empyema, caused by dropped gallstones after LC, are summarized in Table 1.…”
Background
Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC.
Case presentation
We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up.
Conclusions
We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.
“…Notably, 87% of patients underwent a surgical procedure and 12% treated with US ± CT scan guidance drainage, two cases that diagnosed incidentally and were asymptomatic scheduled for regular follow-ups (Table 1 ). One patient died on the 11th postoperative day after lung decortication for thoracic empyema secondary to lost gallstones [ 15 ]. Fig.…”
Introduction
Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years.
Methods
Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature.
Results
Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported.
Conclusions
Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
IntroductionLaparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC.MethodsCase report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022.Case ReportAn 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation.ConclusionIntraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
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