Recurring abdominal wall wounds and cutaneous sinus tract formations secondary to spilled gallstones

Abstract

Introduction: Perforation of an inflamed, gangrenous gallbladder during laparoscopic cholecystectomy inevitably leads to intraoperative spillage of bilious contents and possibly gallstones. In rare cases, spilled gallstones that escape detection during laparoscopic surgical field washout can predispose to multiple types of complications, which are documented in the surgical literature, in the months to years following surgery.Results and Discussion: Spilled gallstones can embed within the abdominal wall musculature in the months following laparoscopic cholecystectomy and serve as a nidus for inflammation and infection. This case demonstrates an instance of simultaneous development of chronically draining wounds and complex cutaneous sinus tracts in both the right flank and periumbilical area secondary to spilled gallstones. These complications began one year after laparoscopic cholecystectomy.Conclusion: Surgical removal of spilled gallstones is necessary to avoid the rare instances where they produce complications of infection, inflammation, and cutaneous sinus tract formations. A 70-year-old female patient presented to our service for evaluation of two separate chronically draining abdominal wall wounds refractory to treatment that developed one year after undergoing a laparoscopic cholecystectomy. After several surgical interventions provided only temporary resolution with eventual recurrence of drainage from the wounds, retained gallstones were discovered as the underlying problem. Overall occurrence of gallstone spillage is documented as occurring in 5%-40% of laparoscopic cholecystectomy cases but sequelae of spilled gallstones are quite rare, appearing in only 0.08%-0.3% of patients.1