RIGHT SUBPHRENIC ABSCESS DUE TO SPILLED GALLSTONES AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

This is the first description of the right subphrenic abscess due to spilled gallstones after laparoscopic cholecystectomy in Japan. A 69-year-old woman underwent laparoscopic cholecystectomy elsewhere on February 16th, 1994, when gallstones spilled into the peritoneal cavity during the operation. She was siezed with a pain on the right back immediately after the operation and had a fever of above 38°C since latter part of the July. She was admitted to the hospital and treated with antibiotic. The fever dropped to normal range. Since late in August, the temperature rose again, and she was readmitted to the hospital. A right subphrenic abscess was revealed, which was continuously drained percutaneously twice without cure. Under laparotomy, the abscess was opened and drained in January, 1995. The abscess contained plenty of pus and nine calcium bilirubinate stones measuring less than 1.2 cm. Cultures of the pus yielded Escherichia coli. The postoperative course was uneventful. Spillage of stones during laparoscopic cholecystectomy may lead to intraperitoneal abscess. During laparoscopic cholecystectomy, major spillage of stones may be an indication for conversion to open cholecystectomy for removal of the stones. every attempt should be made to retrieve stones lost during laparoscopic cholecystectomy, and postoperative surveillance is necessary.