Citation, DOI & article data
Retained gallstones, also called dropped or slipped gallstones, are common during a laparoscopic cholecystectomy, with a reported incidence of 0.1–20%, and occur when gallstones are inadvertently spilled into the peritoneal cavity.
Many cases of dropped gallstones will be asymptomatic. However, patients may become symptomatic if a complication develops and may present with infective symptoms, pain or fistula (e.g. colovesical fistula) formation.
Perforation of the gallbladder during surgery may release a gallstone into the peritoneal cavity. Abscess and fistula formation are possible as a result of the stone. The risk of abscess formation is greater in the setting of dropped pigment stones as the majority of pigment stones contain bacteria 2.
Dropped gallstones may have the following appearances on CT 3:
- initially calcified stones may appear as one or multiple hyperdense foci in Morison's pouch, the gallbladder fossa and the pelvis
- cholesterol or pigmented stones may be more difficult to appreciate
- local abscess or fistula formation may also be evident in some cases
MRI appearance depends on the composition of the stone 4.
Pigmented stones appear as:
- T1: hypertense
Other types of stones appear:
- T1: hypointense
- T2: hypointense
Stones do not show enhancement with contrast.
Treatment and prognosis
The dropped stone will generally need to be removed if it is causing complications (e.g. abscess formation).
Consider the following 4:
- peritoneal loose bodies
- peritoneal metastases: dropped stones may resemble metastatic disease or lymph nodes however the presence of dense calcifications generally favors a dropped stone
- colonic diverticulum
- dropped appendicolith
- 1. Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: postoperative imaging. AJR Am J Roentgenol. 2008;191 (3): 794-801. doi:10.2214/AJR.07.3485 - Pubmed citation
- 2. Woodfield JC, Rodgers M, Windsor JA. Peritoneal gallstones following laparoscopic cholecystectomy: incidence, complications, and management. (2004) Surgical endoscopy. 18 (8): 1200-7. doi:10.1007/s00464-003-8260-4 - Pubmed
- 3. Singh AK, Levenson RB, Gervais DA, Hahn PF, Kandarpa K, Mueller PR. Dropped gallstones and surgical clips after cholecystectomy: CT assessment. (2007) Journal of computer assisted tomography. 31 (5): 758-62. doi:10.1097/RCT.0b013e3180340358 - Pubmed
- 4. Nayak L, Menias CO, Gayer G. Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. (2013) The British journal of radiology. 86 (1028): 20120588. doi:10.1259/bjr.20120588 - Pubmed