Hey, you forgot something! The Management of Symptomatic Retained Gallstones

Abstract

• The majority of dropped gallstones remain asymptomatic; symptomatic complications are extremely rare. • Patients usually present weeks to months to years after their surgery with focalized abdominal pain. • Common CT findings include fluid filled collections that contain multiple calcified gallstones. • Dropped gallstones have been found in multiple locations; this is the first report of stone fragments in sputum. • Today, interventional radiologic procedures are the mainstay of treatment over open surgical removal. Retained gallstones are a rare but potentially morbid condition. When symptomatic they can require drainage and prolonged antibiotics. With the increase in laparoscopic cholecystectomies performed, the incidence of retained gallstones has risen. A retrospective chart review was performed at a 650-bed hospital over 15 years and cases of retained gallstones were identified. A comprehensive literature review was conducted regarding the management of symptomatic retained stones. Fourteen patients were identified to have retained gallstones. Six patients became symptomatic and required interventions. Included in our report is the first case of retained stone fragments coughed up in a patient's sputum. Post-cholecystectomy patients presenting with vague complaints or peri‑hepatic abscesses months to years after cholecystectomy, even when there is no evidence of stones on imaging, should be considered for symptomatic retained gallstones. Interventional radiologic procedures have become the mainstay treatment of choice, with surgeons moving away from open drainage.