The patient's cholecystectomy was complicated by hemorrhage. Post-operative imaging showed a heterogenous/hyperdense fluid collection around the liver, consistent with hematoma. A retained gallstone was seen in this collection, consistent with a dropped gallstone. The cause of the patient's post-operative pain was likely the hematoma and not the dropped gallstone itself, so the patient was treated conservatively without repeat surgical intervention. It is important to recognize a dropped gallstone on radiographs - while gallstones are common and cholecystectomy clips are common, both of these should not be seen simultaneously!

A gallstone may be inadvertently displaced during surgery, remaining within the abdominal cavity - a complication of cholecystectomy known as a dropped gallstone (0.04-19% post-operative frequency) ¹. While dropped gallstones can sometimes lead to abscess formation ^2,3,4, the short interval between the CT scans, the presence of blood products on imaging, and the absence of clinical signs of infection make it unlikely in this case.

Case co-author: Bennett Dwan (Loyola University)