Case Reports
Broncholithiasis and Thoracoabdominal Actinomycosis From Dropped Gallstones

https://doi.org/10.1016/S0003-4975(98)00102-7Get rights and content

Abstract

We report a case of successfully managed invasive, thoracoabdominal actinomycosis caused by the intraperitoneal spillage of gallstones during laparoscopic cholecystectomy. The infected gallstones traversed the diaphragm, migrated into the lung parenchyma, and obstructed a segmental bronchus, causing pneumonia. Treatment involved retrieval of the obstructing stone, debridement and drainage of the pleuroperitoneal phlegmon/abscess, and intravenous antibiotics. The case illustrates the need to remove gallstones at the time of cholecystectomy.

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Comment

Actinomycosis is often described as one of the “great imitators” of abdominal pathology [4]. Abdominal actinomycosis generally presents in the right iliac fossa associated with the ileocecal region of the intestine. As in our case, this lesion is often mistaken for malignant lesions of the abdomen only to be recognized as actinomycosis after pathologic analysis.

The treatment for actinomycosis at any site involves the combination of operation and medical management [4]. Surgical drainage and

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