Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy

Abstract

Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.

Keywords: Intra-abdominal abscess, Spilled gallstone, Laparoscopic cholecystectomy

Core tip: Gallstone abscess resulting from spilled gallstones is a rare complication following laparoscopic cholecystectomy. We report a rare presentation of gallstone abscess due to spilled gallstones following laparoscopic cholecystectomy, mimicking a retroperitoneal sarcoma in a 59-year-old male. Recognizing the patient information about a history of laparoscopic cholecystectomy and sharing the patient information with radiologists can make an accurate diagnosis and avoid misinterpretation when the diagnosis is equivocal in radiologic imaging. Clear documentation of gallbladder perforation and gallstone can help with diagnosis of the complication and for correct management. Five noteworthy features are discussed in this paper.