Pleural empyema due to abandoned gallstones in the diaphragm after laparoscopic cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for patients with symptomatic gallstones. However, complications such as bile duct injuries and spillage of gallbladder contents (bile and gallstones) into the abdominal cavity may occur. Severe complications, including intra-abdominal abscesses and, less frequently, thoracic complications, have been reported related to dropped gallstones.

Case Report: We present a case of a dropped gallstone located between the liver and the diaphragm, which led to the development of an empyema five months after the surgery. The patient underwent laparosco-pic reoperation, during which the gallstone nestled at the diaphragm was successfully removed without complications. Postoperative recovery was favorable, with a one-year follow-up showing no recurrence.

Discussion: Diagnosing such complications involves correlating the history of previous cholecystectomy with imaging findings (e.g., ultrasonography or computed tomography) and microbiological analysis.

Conclusion: The severity of complications that may arise from spilled gallstones to abdomen highlights the importance of avoiding them during laparoscopic cholecystectomy to prevent such events. If intrao-peratively spilled gallstones are detected, they should be immediately removed. In most cases of dropped gallstones, surgical intervention is required to fully resolve the issue, typically leading to favorable outco-mes with minimal complications.