Omental abscess due to a spilled gallstone after laparoscopic cholecystectomy

  • Takeshi Urade
  • Hidehiro Sawa
  • Koichi Murata
  • Yasuhiko Mii
  • Yoshiteru Iwatani
  • Ryoko Futai
  • Shohei Abe
  • Tsuyoshi Sanuki
  • Yukiko Morinaga
  • Daisuke Kuroda
Case Report
  • 17 Downloads

Abstract

Omental abscess due to a spilled gallstone is extremely rare after laparoscopic cholecystectomy. Herein, we report a 68-year-old man who presented with left upper abdominal pain after laparoscopic cholecystectomy for gangrenous cholecystitis. Seven months prior to admission, gallbladder perforation with spillage of pigment gallstones and bile occurred during laparoscopic cholecystectomy. The spilled gallstones were retrieved through vigorous peritoneal lavage. Abdominal computed tomography showed a 3 × 2.5 cm intra-abdominal heterogeneous mass, suspected to be an omental abscess, and ascites around the spleen. Exploratory laparoscopy revealed an inflammatory mass within the greater omentum. Laparoscopic partial omentectomy and abscess drainage were performed, and a small black pigment gallstone was unexpectedly found in the whitish abscess fluid. Abscess fluid culture results were positive for extended-spectrum β-lactamase-producing Escherichia coli and Streptococcus salivarius, which were previously detected in the gangrenous gallbladder abscess. The histopathological diagnosis was abscess in the greater omentum. Postoperative course was uneventful, and the patient was discharged 13 days later. In conclusion, we report a successful case of laparoscopic management of an omental abscess due to a spilled gallstone after LC. It is important to attempt to retrieve spilled gallstones during LC because they may occasionally result in serious complications.

Keywords

Intra-abdominal abscess Laparoscopic cholecystectomy Omental abscess Spilled gallstone 

Notes

Compliance with ethical standards

Conflict of interest

Takeshi Urade, Hidehiro Sawa, Koichi Murata, Yasuhiko Mii, Yoshiteru Iwatani, Ryoko Futai, Shohei Abe, Tsuyoshi Sanuki, Yukiko Morinaga and Daisuke Kuroda declare that they have no conflict of interest.

Human Rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Surgery and Digestive SurgeryKita-Harima Medical CenterOnoJapan
  2. 2.Department of GastroenterologyKita-Harima Medical CenterOnoJapan
  3. 3.Department of Diagnostic PathologyKita-Harima Medical CenterOnoJapan

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