Percutaneous endoscopy (peritoneoscopy) and lithotripsy for retrieval of dropped gallstones post-cholecystectomy

• Authors: Nariman Nezami, University of Maryland; Keywan Behbahani, Emory University; David Elwood, Emory University; Wendy Greene, Emory University; Bill Majdalany, Emory University; Jamil Shaikh, Emory University
• Journal Title: Clinical Endoscopy
• Volume: Volume 55, Number 6
• Publisher: Korean Society of Gastrointestinal Endoscopy. | 2022-11-01, Pages 819-823
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5946/ce.2021.278
• Subjects: Health Sciences, Oncology; Health Sciences, Radiology
• Keywords: post-cholecystectomy

Abstract

The most common complication of laparoscopic cholecystectomy is iatrogenic perforation of the gallbladder, with gallstone spillage into the abdominal cavity. Also known as “dropped gallstones”, this complication occurs in up to 30% of patients, but is clinically silent in the majority of cases.1 If symptoms arise, they are generally related to the complications of dropped gallstones such as abscess and fistulae formation, which often lead to significant morbidity.2,3 The most common location for abscess formation secondary to dropped gallstones is the subhepatic space, more specifically known as Morrison’s pouch.4 The time from spillage of gallstones to abscess formation ranges from 5 days up to 5 years.4,5 Development of inflammatory masses resembling tumors, abdominal wall abscesses, and pleural empyema have also been reported as alternative presentations.1,5 Diagnosis of dropped gallstones is a challenge since majority of gallstones are radio-lucent on computed tomography (CT) and they have the propensity to migrate to different locations.2 Definitive treatment of dropped gallstones is often limited to laparotomy, since laparoscopic retrieval could be technically challenging. Both approaches expose patients to additional morbidity if they are surgical candidates.6