Delayed Presentation of Actinomycotic Intra-Abdominal Abscess Following Laparoscopic Cholecystectomy Complicated by Empyema: Dropped Gallstone to Blame?

Laparoscopic cholecystectomy (LC) has universally become the gold standard for symptomatic gallstone disease. However, there are two specific complications more frequent in LC compared to open cholecystectomy, i.e. injury to the common bile duct and complications from dropped gallstones. Although asymptomatic in majority of cases, adverse events are reported in between 0.08% and 0.3% of these cases. The complications due to dropped stones include abscesses around liver, spleen, diaphragm, retroperitoneum and port sites, broncholithiasis, empyema, peritonitis leading to septicemia, intestinal obstruction, thrombosis of middle colic vein, colocutaneous fistula, and bladder obstruction. Abscesses are the most common infective complications and have been reported to occur from 3.3 months to 10 years. In most cases, E. coli have been identified in abscesses and in cause of septicemia and peritonitis. There are case reports of Klebsiella , Strep. bovis and Samonella being the contaminants after dropped stones. However, actinomycosis as source of infection has rarely been described. We describe a case of an elderly patient who presented with symptoms of shortness of breath and shoulder pain, 2.5 years after cholecystectomy, in whom actinomyces species were cultured from abdominal abscesses. Only few case reports, to our knowledge, have identified actinomyces species as an etiologic agent. We also briefly describe the management of such stones. Clin Infect Immun. 2018;3(1):20-23 doi: https://doi.org/10.14740/cii74e