Transdiaphragmatic abscess: Late thoracic complication of laparoscopic cholecystectomy

Spillage of gallstones into the peritoneal cavity is a frequent problem dur ing laparoscopic cholecystectomy (as much as 30%) and is frequently dismiss ed as a benign occurrence. However, several complications associated with s pillage of gallstones have been reported recently. Most of these complicati ons presented late after the original procedure, many with clinical picture s not related to biliary etiology, confounding and delaying adequate manage ment. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, re gardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallst ones, as most patients will require, not only drainage of fluid collections , but also removal of the stones. A case is described of a patient who pres ented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc res ection of the abscess, repair of the diaphragm, and drainage.