Abstract
IntroductionGiant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of casesCase 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy’s sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. ConclusionsGallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot’s triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties.
Highlights
Giant/large gallstones have high risk of complications, and technical difficulties during surgery
In the current retrospective single-centre case series at Hamad General Hospital in Doha, Qatar, we review three consecutive cases of laparoscopic cholecystectomy (2017–2020) for giant gallstones measuring 6 cm, 4.5 cm and 4.1 cm in diameter respectively, all located in the gallbladder and we report them in line with the PROCESS criteria [10]
Patient was diagnosed as acute cholecystitis and admitted for emergency laparoscopic cholecystectomy (LC) under general anesthesia, placed in supine position, a supra umbilical camera port was inserted in addition to another 3 working ports
Summary
Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. PRESENTATION OF CASES: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy’s sign. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. CONCLUSIONS: Gallstones >5 cm are very rare, with higher risk of complications. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties
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