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Giant gallstone performed by emergency laparoscopic cholecystectomy ☆

View Article: PubMed Central

ABSTRACT

Introduction: Gallstone disease is very common, but the gallstone bigger than 5 cm in diameter is very rare. It is very challenging to be removed by laparoscopic cholecystectomy (LC) and poses extra difficulty in emergency.

Presentation of case: A 70-year-old man complained of abdominal pain in the right upper quadrant with fever of 38 °C for two days. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large gallstone (95 mm × 60 mm × 45 mm). Emergency laparoscopic cholecystectomy was performed successfully.

Discussion: Gallstone over 5 cm in diameter is very rare. LC will be very difficult for these cases, especially for the emergency cases. Emergency laparoscopic cholecystectomy can be successfully performed with clear exposure of the anatomy of the Calot's triangle. To the best of our knowledge, such giant gallstone has been rarely reported.

Conclusion: We have proven that for the rare giant gallstone about 10 cm in size, LC is a feasible option if the anatomy of the Calot's triangle can be clearly exposed; otherwise, open cholecystectomy is a safe choice.

No MeSH data available.


Related in: MedlinePlus

Single giant gallstone measuring 95 mm × 60 mm × 45 mm.
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fig0005: Single giant gallstone measuring 95 mm × 60 mm × 45 mm.

Mentions: A 70-year-old male patient with type 2 diabetes who has had a symptomatic gallstone disease for about 20 years reported having the symptoms of repeatedly pain or discomfort in the right upper quadrant without fever or jaundice after fatty meals. Cholecystectomy was indicated and had been advised several years earlier, but he did not wish to undergo the surgical procedure. This time, he had two days of progressively increasing right upper quadrant pain. He had a fever of 38 °C. On physical examination, he had abdominal tenderness on the right upper quadrant. The routine laboratory tests were normal except for white blood cell count of 21,000/mm3. Abdominal ultrasound demonstrated the presence of a solitary giant gallstone (100 mm × 60 mm × 50 mm). Emergency LC was carried out on the day of admission. LC with three ports was performed. During operation, since the stone fully filled gallbladder with little fluid, it is difficult to grasp the gallbladder, so the gallbladder was held with the grasper open to maintain the tension between the gallbladder and gallbladder bed to dissect. Because the lithotomy forceps could not crumb the giant hard gallstone, the subxiphoid trocar incision was extended to pick out the gallbladder with specimen retrieval bag. The gallbladder contained a single giant gallstone measuring 95 mm × 60 mm × 45 mm (Fig. 1). The patient's postoperative recovery was uneventfully and he was discharged on the postoperative third day.


Giant gallstone performed by emergency laparoscopic cholecystectomy ☆
Single giant gallstone measuring 95 mm × 60 mm × 45 mm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860022&req=5

fig0005: Single giant gallstone measuring 95 mm × 60 mm × 45 mm.
Mentions: A 70-year-old male patient with type 2 diabetes who has had a symptomatic gallstone disease for about 20 years reported having the symptoms of repeatedly pain or discomfort in the right upper quadrant without fever or jaundice after fatty meals. Cholecystectomy was indicated and had been advised several years earlier, but he did not wish to undergo the surgical procedure. This time, he had two days of progressively increasing right upper quadrant pain. He had a fever of 38 °C. On physical examination, he had abdominal tenderness on the right upper quadrant. The routine laboratory tests were normal except for white blood cell count of 21,000/mm3. Abdominal ultrasound demonstrated the presence of a solitary giant gallstone (100 mm × 60 mm × 50 mm). Emergency LC was carried out on the day of admission. LC with three ports was performed. During operation, since the stone fully filled gallbladder with little fluid, it is difficult to grasp the gallbladder, so the gallbladder was held with the grasper open to maintain the tension between the gallbladder and gallbladder bed to dissect. Because the lithotomy forceps could not crumb the giant hard gallstone, the subxiphoid trocar incision was extended to pick out the gallbladder with specimen retrieval bag. The gallbladder contained a single giant gallstone measuring 95 mm × 60 mm × 45 mm (Fig. 1). The patient's postoperative recovery was uneventfully and he was discharged on the postoperative third day.

View Article: PubMed Central

ABSTRACT

Introduction: Gallstone disease is very common, but the gallstone bigger than 5 cm in diameter is very rare. It is very challenging to be removed by laparoscopic cholecystectomy (LC) and poses extra difficulty in emergency.

Presentation of case: A 70-year-old man complained of abdominal pain in the right upper quadrant with fever of 38 °C for two days. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large gallstone (95 mm × 60 mm × 45 mm). Emergency laparoscopic cholecystectomy was performed successfully.

Discussion: Gallstone over 5 cm in diameter is very rare. LC will be very difficult for these cases, especially for the emergency cases. Emergency laparoscopic cholecystectomy can be successfully performed with clear exposure of the anatomy of the Calot's triangle. To the best of our knowledge, such giant gallstone has been rarely reported.

Conclusion: We have proven that for the rare giant gallstone about 10 cm in size, LC is a feasible option if the anatomy of the Calot's triangle can be clearly exposed; otherwise, open cholecystectomy is a safe choice.

No MeSH data available.


Related in: MedlinePlus