Digestive complications of gallstones lost during laparoscopic cholecystectomy

Introduction

Serious complications can ensue if a gallstone is dropped into the peritoneal cavity during laparoscopic cholecystectomy and not retrieved.

Case outline

A 75 year old man was admitted with intestinal obstruction 8 years after laparoscopic cholecystectomy. Ultrasound scan and a contrast x‐ray of the small bowel showed a gallstone within the small bowel lumen that CT scan had failed to identify. Laparotomy showed a Meckel's diverticulum plus a 4 × 6‐cm gallstone in the terminal ileum. The gallstone had penetrated into the Meckel's diverticulum before migrating into the ileum and obstructing it.

Discussion

Gallstones lost during laparoscopic cholecystectomy can cause an intraperitoneal abscess. In addition, they can migrate through the anterior or posterior abdominal wall or the diaphragm and into the urinary tract or bronchus. The resulting abscess can obstruct the digestive tract or drain into the digestive tract to cause a communicating abscess. It can also drain through the abdominal wall and the digestive tract to cause an enterocutaneous fistula. Lastly, the stone can migrate into the intestine and cause gallstone ileus. Following laparoscopic cholecystectomy, patients with a lost gallstone may suffer from abdominal pain and fever within days or months. Thus, all dropped gallstones should be removed during laparoscopy.