Case 110: Lost Stones
A 55 year old man underwent laproscopic cholecystectomy 1 month ago. He now presents with central abdominal pain and fever.
1. What appears to be the problem?
The CT shows a fluid collection containing a radiodense round object that is likely to be a residual gallstone lost at the time of operation.
2. How would you manage this problem?
This requires operative drainage as demonstrated in the photo to drain the pus and remove the stone which is the nidus of infection. Complications from spilt gallstones are uncommon however all reasonable efforts should be made at the time of cholecystectomy to avoid perforation and spillage of stones. If stones are spilt they may be retrieved via a scoop instrument or in a bag.
It is likely that most spilt stones do not cause any significant complications and therefore it is not usually justified to convert from laparoscopic to an open technique simply to retrieve stones.
PubMed - Gallstone abscess