Spilled Gallstones

General Considerations

• Laparoscopic cholecystectomy (LC) is associated with spillage of gallstones about 5-40% of the time
• Occurs less frequently in open procedures
• Incidence more common in
  • Acutely inflamed gallbladder
  • Men
  • Obese
  • Elderly
  • Presence of adhesions

• Stones may migrate over time and also tend to be dispersed by irrigation and pneumoperitoneum
• Majority of cases, there are no complications
• Infective complications more common with bilrubinate stones which often contain bacteria

Clinical Findings

• In the unusual instance of an abscess developing, there may be pain and fever
• But many patients may be afebrile with a normal white count
• Diagnosis depends on history of prior cholecystectomy

Imaging Findings

• CT, US or MRI may be used
• Single or multiple radioopaque calculi outside of normal luminal structures such as the GI or GU tract
• Stones may have no surrounding reaction
• Abscess formation, especially one or multiple abscesses containing  calcifications in a patient with a history of LC
  • Sometimes stone may be non-opaque and not be visible

Treatment

• Attempts are made to retrieve spilled stones at the time of surgery
• Converting to an open procedure is controversial but is usually not done

Complications

• Rare (0.08-0.3%)
• Complications include
  • Abscess formation- one month to 20 years with a peak at 4 months
  • Intestinal obstruction
  • Migration to the chest or urinary tract
  • Septicemia

Spilled Gallstones. Lower photo is close-up of axial CT scan prior to the patient undergoing a laparoscopic cholecystectomy demonstrating a gallbladder filled with numerous radioopaque stones (red circle).. The upper photos are 6 months later and show numerous gallstones (red circles) throughout the peritoneal cavity spilled at the time of surgery. The patient's symptoms were unrelated to the spilled stones which show no evidence of abscess formation..
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Spilled gall stones during laparoscopic cholecystectomy: a review of the literature.  T Sathesh-Kumar, A P Saklani, R Vinayagam, R L Blackett. Postgrad Med J 2004;80:77–79.