Dropped gallstones eroding into the abdominal wall

Case contributed by Dr Michael P Hartung

Presentation

Right upper quadrant pain.

Patient Data

Age: 70 years
Gender: Male

Mildly dilated gallbladder, mildly thickened wall, gallstones, and relatively subtle pericholcystic inflammation/stranding. 

Polycystic kidneys with numerous calyceal stones. 

Postoperative changes of cholecystectomy with small amount of organizing fluid, clips, and a few stones in the cholecystectomy bed. 

Small organizing collection along the anterior aspect of the pylorus. 

Additional collections of spilled gallstones layer along the anterior/inferior right hepatic lobe. 

Collections along the inferior right hepatic lobe, abdominal wall musculature, and subcutaneous fat which contain fluid and several punctate gallstones. 

Case Discussion

Gangrenous cholecystitis complicated by spilled gallstones, postoperative abscess formation and drainage, and more delayed presentation of right flank mass containing fluid/stones eroding through the right lateral abdominal wall. 

This case highlights the inflammatory nature of dropped gallstones and how they can result in delayed complications, and the importance of reviewing previous imaging in order to piece the story together. 

Dropped gallstones result from perforation of the gallbladder during cholecystectomy. While often they do not cause any patient harm, they can result in abscess or fistula formation after weeks, months, or even years 1.

This patient was managed with incision and drainage, with a note of several small foreign bodies resembling fragmented gallstones. 

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