Abscess formation due to lost stones during laparoscopic cholecystectomy

Two women aged 79 and 69 years presented with abdominal pain at I5 and 38 months respectively after a laparoscopic cholecystectomy. In both cases perforation of the gallbladder had occurred with spillage of bile and gallstones. A CT-scan carried out at presentation showed signs of an an abdominal abscess. The origin of the abscess was initially dut. The first patient was operated on immediately. In the second patient a drain was placed in the abscess under ultrasound guidance. During operation gallstones were seen in the abscess cavity in both patients. Both patients recovered well. Although perforation of the gallbladder with spillage of gallstones during laparoscopic cholecystectomy often occurs, the incidence of major postoperative complications is low. However, in some cases reoperation is necessary. Removal of all spilled stones is therefore indicated to prevent complications. If abdominal symptoms persist after laparoscopic cholecystectomy, an abscess due to spilled gallstones should be considered. Ultra-sound or CT are the most sensitive means of for tracing spilled gallstones or abscesses.