Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4421-4426
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4421
Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy
Bum-Soo Kim, Sun-Hyung Joo, Hyun-Cheol Kim
Bum-Soo Kim, Sun-Hyung Joo, Hyun-Cheol Kim, Division of Hepatobiliary Surgery, Department of Surgery, Kyung Hee University Hospital at Gandong, Kyung Hee University School of Medicine, Seoul 134-727, South Korea
Author contributions: Kim BS designed and wrote the paper; Joo SH supported writing of the paper; Kim HC reported radiologic imaging.
Institutional review board statement: This case report was approved by Kyung Hee University Hospital at Gangdong Institutional Review Board (KHNMC IRB 2015-12-008).
Informed consent statement: Informed consent was obtained from the patient for reporting this case.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bum-Soo Kim, MD, PhD, Division of Hepatobiliary Surgery, Department of Surgery, Kyung Hee University Hospital at Gandong, Kyung Hee University School of Medicine, 892 Dongnam Ro, Gangdong Gu, Seoul 134-727, South Korea. kbs420@hanmail.net
Telephone: +82-2-4406119 Fax: +82-2-4406295
Received: December 18, 2015
Peer-review started: December 22, 2015
First decision: January 13, 2016
Revised: January 21, 2016
Accepted: February 22, 2016
Article in press: February 22, 2016
Published online: May 7, 2016
Processing time: 132 Days and 23.8 Hours
Abstract

Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.

Keywords: Intra-abdominal abscess; Spilled gallstone; Laparoscopic cholecystectomy

Core tip: Gallstone abscess resulting from spilled gallstones is a rare complication following laparoscopic cholecystectomy. We report a rare presentation of gallstone abscess due to spilled gallstones following laparoscopic cholecystectomy, mimicking a retroperitoneal sarcoma in a 59-year-old male. Recognizing the patient information about a history of laparoscopic cholecystectomy and sharing the patient information with radiologists can make an accurate diagnosis and avoid misinterpretation when the diagnosis is equivocal in radiologic imaging. Clear documentation of gallbladder perforation and gallstone can help with diagnosis of the complication and for correct management. Five noteworthy features are discussed in this paper.