Chronic discharging sinus out of missed stone during laparoscopic cholecystectomy: a rare and late complication

Abstract

Introduction: Gallbladder perforation can occur in 6 – 40% of laparoscopic cholecystectomy (LC) procedures. In up to a third of these cases, stones cannot be retrieved and complications can arise many years post-operatively. I am presenting here the fate of the spilled over gall bladder stones during laparoscopic cholecystectomy in an old lady. Method: A 52 -year-old woman who presented with discharging sinus that developed four years after LC from one of post surgical site. Radiological studies showed a sinus tract of size around 8 cms. With an abscess formation at the sub hepatic region with some echoreflective structure inside. The whole of the sinus tract was excised and the collection drained. Multiple gall stones were found in the cavity which was spilled during her surgery. Results: The incidence of perforation ranged from 9% to 40% whereas stones retained in 1% – 13%.Recognised symptoms include abdominal pain, fever, abdominal abscess, and the presence of a sinus formation and present in variable time periods .It is crucial to minimise the number of stones spilled by meticulous dissection and use endo bag for specimen retrieval, attempt to retrieve all stray stones and to copiously irrigate the peritoneal cavity. Possibly the most important aspect in the management of stone spillage is documentation. Conclusion: Gallbladder perforation during is a reasonably common problem and may result in spilled stones and may lead to complications. Should spillage occur, clear documentation and a high index of suspicion should be maintained for early recognition and treatment of complications.