Percutaneous CT-guided retrieval of a retained gallstone to treat a cutaneous fistula following cholecystectomy

Abstract

This case report describes a technique for the removal of a subcutaneously retained gallstone in a patient who had previously undergone laparoscopic cholecystectomy. The patient’s laparoscopic cholecystectomy was complicated by a perihepatic abscess which was drained percutaneously. The percutaneous abscess drainage was complicated by persistent drainage of tiny stones through the drain tract after the drainage catheter was removed. His computed tomography (CT) revealed a cutaneous fistula between the gallbladder fossa and the right flank with retained gallstones. Despite multiple outpatient general surgery visits, the patient’s wound would not heal, and interventional radiology was consulted for management. Using CT guidance, a retained stone in the right flank was targeted, and a percutaneous approach involving serial dilation and retrieval with a 2.4F × 120 cm Boston Scientific Segura Hemisphere Stone Retrieval Basket (Boston Scientific, Marlborough, MA) through an 18F × 40 cm Cook Check-Flo Performer introducer sheath (Cook, Bloomington, IN) was performed. Similar techniques are used in retrieval of intraluminal objects; however, this is a case in which an object lodged within the soft tissues was retrieved using Seldinger technique.