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Abscess formation following spilled gallstones during laparoscopic cholecystectomy.

Brueggemeyer MT, Saba AK, Thibodeaux LC - JSLS (1997 Apr-Jun)

Bottom Line: The English literature was reviewed, and characteristics of the case reports found in the literature were compared.Twenty-three cases were found in the literature.The older population appears to be at greater risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.

ABSTRACT

Objective: Our purpose was to report the occurrence of abscess following spilled gallstones during laparoscopic cholecystectomy as experienced at Good Samaritan Hospital, and to compare it to the experience of other institutions in order to identify the incidence, characteristics and possible risk factors for the development of this complication.

Methods: Four case reports of abscess following spilled gallstones during laparoscopic cholecystectomy are presented. The English literature was reviewed, and characteristics of the case reports found in the literature were compared.

Results: In four years at this institution, four reports of abscess formation following laparoscopic cholecystectomy have been identified. Two occurred in elderly females and were located in the right flank in both. Two were in middle-aged men, both diabetic. One abscess was in the right flank and one in the right pleural space. Twenty-three cases were found in the literature. The average age was 65 years; there were 12 men and 11 women. The locations of abscess formation were trocar sites (most common), right subphrenic space, right flank or retroperitoneum, and pelvis. The average time to presentation was 4-5 months (range 4 days-12 months).

Conclusions: Abscess formation following spilled gallstones during laparoscopic cholecystectomy occurs infrequently, but can be debilitating and require more than one procedure. The older population appears to be at greater risk. Future prospective studies of patients who undergo laparoscopic cholecystectomy are needed to more accurately determine the incidence of this complication and to identify the population at risk.

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Related in: MedlinePlus

Retroperitoneal abscess three months after laparoscopic cholecystectomy. Stones were spilled during the procedure. Stones were removed during open debridement.
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Figure 1: Retroperitoneal abscess three months after laparoscopic cholecystectomy. Stones were spilled during the procedure. Stones were removed during open debridement.

Mentions: Six weeks following coronary artery bypass grafting (CABG), a 58-year-old white male with uncontrolled diabetes developed right upper quadrant pain, nausea, vomiting and elevated liver function tests. He underwent laparoscopic cholecystectomy for acute cholecystitis. There was spillage of stones and bile during the case and only some of the stones were retrieved. His initial postoperative course was uneventful. He presented three months later, febrile, complaining of right upper quadrant and right flank pain. Computed tomography (CT) of the abdomen revealed a large subhepatic and retroperitoneal fluid collection which was percutaneously drained (Figure 1). The culture grew Klebsiella. He was treated with intravenous piperacillin and then switched to oral ciprofloxacin for a ten day course. His symptoms were relieved only to recur two months later. The CT scan showed recurrence of the abscess (Figure 2). He was taken to the operating room for a posterior exploration that revealed retained gallstones at the base of the abscess. These were removed and the wound debrided and irrigated. The culture again grew Klebsiella sensitive to ciprofloxacin. He was discharged with another course of ciprofloxacin and wound care. He returned again five months later to have further debridement. He has since required another exploration in the operating room and is currently recovering.


Abscess formation following spilled gallstones during laparoscopic cholecystectomy.

Brueggemeyer MT, Saba AK, Thibodeaux LC - JSLS (1997 Apr-Jun)

Retroperitoneal abscess three months after laparoscopic cholecystectomy. Stones were spilled during the procedure. Stones were removed during open debridement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021270&req=5

Figure 1: Retroperitoneal abscess three months after laparoscopic cholecystectomy. Stones were spilled during the procedure. Stones were removed during open debridement.
Mentions: Six weeks following coronary artery bypass grafting (CABG), a 58-year-old white male with uncontrolled diabetes developed right upper quadrant pain, nausea, vomiting and elevated liver function tests. He underwent laparoscopic cholecystectomy for acute cholecystitis. There was spillage of stones and bile during the case and only some of the stones were retrieved. His initial postoperative course was uneventful. He presented three months later, febrile, complaining of right upper quadrant and right flank pain. Computed tomography (CT) of the abdomen revealed a large subhepatic and retroperitoneal fluid collection which was percutaneously drained (Figure 1). The culture grew Klebsiella. He was treated with intravenous piperacillin and then switched to oral ciprofloxacin for a ten day course. His symptoms were relieved only to recur two months later. The CT scan showed recurrence of the abscess (Figure 2). He was taken to the operating room for a posterior exploration that revealed retained gallstones at the base of the abscess. These were removed and the wound debrided and irrigated. The culture again grew Klebsiella sensitive to ciprofloxacin. He was discharged with another course of ciprofloxacin and wound care. He returned again five months later to have further debridement. He has since required another exploration in the operating room and is currently recovering.

Bottom Line: The English literature was reviewed, and characteristics of the case reports found in the literature were compared.Twenty-three cases were found in the literature.The older population appears to be at greater risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.

ABSTRACT

Objective: Our purpose was to report the occurrence of abscess following spilled gallstones during laparoscopic cholecystectomy as experienced at Good Samaritan Hospital, and to compare it to the experience of other institutions in order to identify the incidence, characteristics and possible risk factors for the development of this complication.

Methods: Four case reports of abscess following spilled gallstones during laparoscopic cholecystectomy are presented. The English literature was reviewed, and characteristics of the case reports found in the literature were compared.

Results: In four years at this institution, four reports of abscess formation following laparoscopic cholecystectomy have been identified. Two occurred in elderly females and were located in the right flank in both. Two were in middle-aged men, both diabetic. One abscess was in the right flank and one in the right pleural space. Twenty-three cases were found in the literature. The average age was 65 years; there were 12 men and 11 women. The locations of abscess formation were trocar sites (most common), right subphrenic space, right flank or retroperitoneum, and pelvis. The average time to presentation was 4-5 months (range 4 days-12 months).

Conclusions: Abscess formation following spilled gallstones during laparoscopic cholecystectomy occurs infrequently, but can be debilitating and require more than one procedure. The older population appears to be at greater risk. Future prospective studies of patients who undergo laparoscopic cholecystectomy are needed to more accurately determine the incidence of this complication and to identify the population at risk.

Show MeSH
Related in: MedlinePlus