University of South Dakota Sanford School of Medicine Sioux Falls, SD
Muhammad Waleed, MD1, Muhammad Hassaan Arif Maan2, Muhammad Arsalan Arshad, MD1, Muhammad Soban Arif Maan, MBBS2; 1University of South Dakota Sanford School of Medicine, Sioux Falls, SD; 2Aga Khan University, Karachi, Sindh, Pakistan
Introduction: Laparoscopic Cholecystectomy is the treatment of choice for symptomatic cholelithiasis and is among the most done procedures in United States. Spillage of gallstones occurs in up to 30% of these procedures and is associated with rare but important complications including abscess formation. These complications often have an unusual and remote presentation which makes for a difficult diagnosis.
Methods: We present a case of 44 years old gentleman with worsening right sided abdominal pain for last 2 weeks. His history was notable for a laparoscopic cholecystectomy 3 years back and right sided perihepatic fluid collection first visualized on CT scan 4 months ago. Multiple percutaneous drainages and antibiotic courses had failed to provide a definitive resolution. CT abdomen was repeated which showed an increase in size of irregular, ring-enhancing complex fluid collection in right perihepatic space suspicious for a developing abscess (Fig 1 & Fig 2). Bearing in mind the history of laparoscopic cholecystectomy and the non-resolving nature of the abscess, spilled gallstones were considered as possible nidus for infection and General Surgery was consulted. A diagnostic laparoscopy was performed, and multiple retained stones were visualized. It was converted to open laparotomy and the abscess was drained along with resection of segment VI of liver and a part of diaphragm. The patient remained vitally stable with no fever spikes following the procedure. Discussion: A high index of suspicion for retained gallstones should be maintained in all patients presenting with abdominal abscess with a history of previous laparoscopic cholecystectomy, even if the imaging studies do not provide evidence of stones. Percutaneous drainage and antibiotics may provide temporary relief, but a surgical intervention is often the definitive management.
Coronal section for CT Abdomen showing irregular, ring-enhancing complex fluid collection in right perihepatic space (arrow)
Disclosures: Muhammad Waleed indicated no relevant financial relationships. Muhammad Hassaan Arif Maan indicated no relevant financial relationships. Muhammad Arsalan Arshad indicated no relevant financial relationships. Muhammad Soban Arif Maan indicated no relevant financial relationships.