Uncontrolled hypertension. CT renal angiogram to rule out renal artery stenosis.
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Axial CT images through upper abdomen show multiple hyperdense nodular lesions in right subphrenic space and in subhepatic space anterior to hepatoduodenal ligament. Surgical clips are also seen in gall bladder fossa related to previous cholecystectomy surgery.
This patient was operated 8 years back by laproscopic cholecystectomy. Intraoperatively spillage of calculi was seen. Since the calculi were small and numerous no further attempt was made for retrieval. The patient was asymptomatic after surgery.
Dropped gallstones are an infrequent but important source of complications after laparoscopic cholecystectomies (LC) as a result of gallbladder perforation during surgical dissection and extraction. Most of these stones are evacuated intraoperatively, but fragmented and inaccessible stones are left in the peritoneal cavity. In most cases, these stones cause no complications.
In rare instances, dropped gallstones become symptomatic, resulting in a wide range of complications with considerable associated morbidity. In particular, recurrent abscesses due to unrecognized gallstones can cause considerable morbidity. A high index of suspicion is essential for prompt diagnosis. Radiologists should suspect dropped gallstones in any patient who has undergone LC and has any abscess of unknown cause, regardless of location or temporal latency.
- Out of Sight but Kept in Mind: Complications and Imitations of Dropped Gallstones. American Journal of Roentgenology. 2013;200: 1244-1253.
- Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. Br J Radiol 2013;86: 20120588.