Connect
MJA
MJA

A spilled gallstone

Edgard Wehbe, Reggie J Voboril and Elisha J Brumfield
Med J Aust 2007; 187 (7): 397.
Published online: 1 October 2007

An 80-year-old woman presented with abdominal pain, nausea and diarrhoea. She had undergone a laparoscopic cholecystectomy 10 years previously. The surgery was complicated by an umbilical hernia at the umbilical port site, which was repaired surgically 5 years later. The patient reported intermittent drainage of clear fluid from the umbilicus after the hernia repair. She had right lower quadrant tenderness without guarding or a palpable mass.

Laboratory investigations showed a serum lipase concentration of 393 U/L (reference range, 114–286 U/L) with normal white blood cell count. Abdominal computed tomography revealed a 2.8 × 2.4 cm mass in the right lower quadrant, with a calcific rim and foci of calcium within the lesion (Figure, A). The mass appeared to be outside the small bowel, suggesting a mucocele or mucoid tumour. Laparoscopy revealed a 2.5 cm solid mass containing a gallstone (Figure, B and C). The drainage from the umbilicus continued after surgery and was apparently unrelated to the spilled gallstone.

Gallstone spillage is more common during laparoscopic than open cholecystectomy. It occurs in 5%–40% of laparoscopic cholecystectomies, but complications are very rare,1 with a reported incidence of 0.08%–0.3% of cases.2 The reason that only a fraction of patients develop complications is uncertain.1

Figure

A: Computed tomography scan of the abdomen showing a 2.8 × 2.4 cm mass (arrow) external to the small bowel. B, C: The gallstone recovered during exploratory laparoscopy.

  • Edgard Wehbe1
  • Reggie J Voboril2
  • Elisha J Brumfield3

  • School of Medicine — Wichita, University of Kansas, Wichita, Kan, United States.

Correspondence: edgardwehbe@hotmail.com

  • 1. Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL. Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. Postgrad Med J 2004; 80: 77-79.
  • 2. Schafer M, Suter C, Klaiber C, et al. Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 1998; 12: 305-309.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.