EP 533 Dropped Gallstones Following Laparoscopic Cholecystectomy
Minaa Alrawe, Sandeep Samson, Suvi VirupakshaAbstract
Aims
Dropped gallstones following laparoscopic cholecystectomy are an uncommon complication and may present late with atypical infective collections. This case aims to highlight a rare presentation of dropped gallstones manifesting as a large posterior abdominal wall abscess.
Methods
We report the case of a 63-year-old male who presented with a progressively enlarging and painful right lower back mass over three weeks, associated with reduced appetite and constipation, but no systemic symptoms. Clinical examination revealed a large fluctuant right lumbar mass measuring approximately 17 × 14 cm without overlying skin changes. Laboratory investigations demonstrated significantly raised inflammatory markers. Initial ultrasound showed a deep cystic lesion, and subsequent MRI confirmed a complex collection extending along the right thoracolumbar fascia with intra- and extra-abdominal components, abutting the right psoas and latissimus dorsi muscles, without bony involvement.
Results
The patient underwent ultrasound-guided percutaneous drainage, yielding approximately 600 mL of purulent material. Microbiological cultures grew Escherichia coli. Multidisciplinary review of imaging findings suggested the collection was secondary to dropped gallstones from a previous laparoscopic cholecystectomy, which had not been initially disclosed by the patient. Following drainage and targeted antibiotic therapy, the patient demonstrated marked clinical improvement with normalization of inflammatory markers and was discharged with outpatient follow-up.
Conclusions
Dropped gallstones should be considered in the differential diagnosis of unusual posterior abdominal wall or paraspinal abscesses, even years after laparoscopic cholecystectomy. Early recognition and image-guided drainage can result in excellent clinical outcomes and avoid unnecessary surgical intervention.