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      Right lumbar abscess containing a gallstone—an unexpected late complication of laparoscopic cholecystectomy

      case-report

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          Abstract

          During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.

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          Lost gallstones in laparoscopic cholecystectomy: all possible complications.

          Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones. A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones. Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.
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            Spilled gall stones during laparoscopic cholecystectomy: a review of the literature.

            Laparoscopic cholecystectomy is associated with spillage of gall stones in 5%-40% of procedures, but complications occur very rarely. There are, however, isolated case reports describing a range of complications occurring both at a distance from and near to the subhepatic area. This review looks into the various modes of presentation, ways to minimise spillage, treating the complications, and the legal implications.
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              Complications due to gallstones lost during laparoscopic cholecystectomy.

              The aim of this study was to identify predisposing factors for complications after gallstone spillage during laparoscopic cholecystectomy (LC). Papers derived from Medline search and papers from reference lists within these papers were studied. Ninety-one reports on complications caused by lost gallstones published between 1991 and 1998 were analyzed. These patients were compared with cases in published series on LC in general. Gallbladder perforation (20%) and stone spillage (9%) were the two most common complications of LC which occurred during the dissection (75%) and removal (25%) of the gallbladder. Predisposing factors for developing complications after stone spillage were: older age, male sex, acute cholecystitis, spillage of pigment stones, number of stones (>15) or size of the stone (Ø > 1.5 cm), and perihepatic localization of lost stones. CT-scan and ultrasound examination proved best for the recognition of complications caused by lost stones. Explorative laparotomy and surgical removal of the stones was the most frequently used therapy. Gallbladder perforation and stone spillage might cause hazardous complications. In cases with loss of numerous or large pigment stones which cannot be retrieved by laparoscopy, intraoperative conversion to open surgery can be justified.
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                Author and article information

                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                July 2020
                31 July 2020
                31 July 2020
                : 2020
                : 7
                : rjaa248
                Affiliations
                [1] Department of General Surgery , Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD) , Vila Real, Portugal
                Author notes
                Correspondence address. Department of General Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), Vila Real 5000-508, Portugal. Tel: +351-259-300-500; Fax: +351-259-300-503; E-mail: amarcal@ 123456chtmad.min-saude.pt
                Article
                rjaa248
                10.1093/jscr/rjaa248
                7394135
                32760493
                d593ec29-483b-47ab-89b0-36b32ff471fc
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 2 June 2020
                : 18 June 2020
                Page count
                Pages: 3
                Categories
                AcademicSubjects/MED00910
                jscrep/080
                Case Report

                cholelithiasis,lumbar abscess,spilled gallstones,cholecystectomy

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