CT - Subsequent CT
What is the diagnosis for this patient?
A retained or "dropped" gallstone, a surgical complication where gallstones drop out of the gallbladder during a cholecystectomy and remain in the abdominal cavity.
What is the incidence rate of a dropped gallstone?
Dropped gallstones occur at an estimated rate of 0.04% to 19% during a cholecystectomy.
What are the possible complications of a dropped gallstone?
Dropped gallstones can become a nidus for infection and lead to the formation of abscesses within the abdomen. They can also potentially cause chronic abdominal pain, peritonitis, bowel obstruction, fistula formation, sinus tract formation, granuloma formation, and bile duct obstruction.
How can a dropped gallstone be managed?
A dropped gallstone that presents without symptoms may not require intervention. Management of the dropped gallstone involves monitoring for complications such as infection, abscess formation, or fistula development, and surgical intervention if necessary.
Subsequent CT of the abdomen and pelvis with IV contrast shows postsurgical changes of recent cholecystectomy with surgical clips, fluid, and gas in the gallbladder fossa. There is a new subscapular fluid collection along the lateral aspect of the right hepatic lobe, likely hemorrhagic given areas of hyperdensity. This collection appears continuous with the fluid in the gallbladder fossa via the interlobar fissure. There is a calcified structure in the posterior aspect of the fluid collection, similar in size and shape to the gallstone seen on the initial pre-operative CT, although inverted compared to the prior CT on coronal images. A small amount of free fluid is noted in the pelvis. A small right pleural effusion is present.