Spilled Gallstones during Laparoscopic Cholecystectomy: Case Series and Review of Literature

Patient is a 76-year-old man with past medical history of hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, chronic renal insufficiency, alcoholic cirrhosis who was diagnosed with cholelithiasis in 2015. He subsequently developed cholecystitis, which was complicated by choledocholithiasis with cholangitis, requiring ERCP with biliary stent, followed by laparoscopic cholecystectomy. There was no documentation of spilled stones or any other complication during the surgery. Two years after laparoscopic cholecystectomy [2], patient presented with abdominal distention and pain predominantly in the epigastric region, not related to food. Abdomen CT scan showed subphrenic fluid collection extending along right abdominal wall with two to three calcified spilled gallstones. During the hospital course, patient developed fever, leukocytosis and tachycardia. He was diagnosed with sepsis and treated for suspected pneumonia. Patient underwent interventional radiology (IR) guided drainage for multiloculated complex hepatic fluid. Eight hundred milliliters of greenish viscous fluid were aspirated [3]. Culture from intraperitoneal aspiration is negative. IR failed to remove gallstone after dilating the access. Patient underwent an extensive peritoneal washout and perihepatic fluid collection resolved Figure 1. Figure 1: 76 years old Male with Subphrenic Heterogenous Fluid Collection extending Right Abdominal Wall.