Spilled gallstones following laparoscopic cholecystectomy: A report of two cases

Background

Abdominal complications due to spilled gallstones after laparoscopic cholecystectomy are a rare event and may occur months, or even years after the operation.

Case report

We present two cases:

1. a)
   A 62-year-old female patient, who was submitted to an uneventful laparoscopic cholecystectomy, and whose immediate post-operative course was delayed due to a persistent small bowel obstruction. Exploratory laparotomy revealed a mass, consisting of joined gallstones that caused strong adhesions between the loops of the terminal ileum.
    
2. b)
   A 67 year-old male patient, with a “lost” gallstone presenting as an epigastric mass, 18 months after an uneventful laparoscopic cholecystectomy for gallstone disease. Exploratory laparotomy revealed a mass, full of pus and inflammatory tissues, in the core of which a pigmented gallstone with a diameter of 3 cm was found.
    

Conclusion

The surgeon should always try to avoid causing a gallbladder perforation during laparoscopic cholecystectomy. In case that a perforation occurs, the surgeon should meticulously try to collect all–if possible–the spilled gallstones. Patients should always be aware of this event postoperatively. This must also be documented in the discharge notes, in order to assist the early recognition and treatment of any future complications.