Background : Laparoscopic cholecystectomy has been the gold standard of treatment for gallstones, and it is also known that spilled gallstones occur in 5% to 40% of patients during this procedure. However, complications associated with spilled gallstones, such as intra-abdominal abscesses, were uncommon. Herein, we report a case of intraabdominal abscess caused by spilled gallstones following laparoscopic cholecystectomy.

Methods : A 58-year-old male was admitted to emergency room, presenting with 2 months history of progressing right-sided dull abdominal pain. Outside abdominal ultasonography revealed about a 5 cm mass-like lesion in the sub-hepatic space. He had no significant past medical history except a history of laparoscopic cholecystectomy about 19 months previously. Laboratory test showed a C-Reactive Protein of 1.72mg/dL. All other laboratory findings including leukocyte count were within normal limits. Abdominal computed tomography (CT) scan defined a 5.8 cm × 4.7 cm cystic mass including a small hypodense lesion with thick wall in the right subhepatic space and a tiny distal common bile duct stone.

Results : With the suspicion that the cystic mass including a tiny hypodense lesion was an abscess cavity caused by a spilled gallstone , percutaneous catheter drainage (PCD) was performed, initially. For a biliary stone, endoscopic retrograde retrograde cholangiopancreatography was performed to remove the stone. 10 days later after PCD, the gallstone was removed using a stone basket through a PCD under guidance of real-time radiologic image. The abdomen CT taken 2 months after stone removal revealed successful improvement from abscess formation.

Conclusions : In conclusion, intraabdominal abscess formation secondary to spilled gallstones following laparoscopic cholecystectomy is an unusual event. With the suspicion of intraabdominal abscess due to spilled gallstones following cholecystectomy, we should consider the PCD for treatment and removal of gallstone.