Retroperitoneal abscess after retained stones during laparoscopic cholecystectomy

Laparoscopic cholecystectomy is associated with a significant risk of gallb ladder perforations with bile and stone spillage. The retrieval of dropped stones is sometimes impossible, and intraperitoneally retained stones can b e the source of serious complications, such as inflammatory masses or absce sses. The authors describe a patient in whom a large retroperitoneal absces s developed as a result of missed stone fragments during cholecystectomy. A lthough several cases of intraperitoneal abscess have been reported in the literature, retroperitoneal collection is very uncommon. Crushed and infect ed stones seem to be the essential prerequisite for abscess formation. Ther efore, every attempt should be made to avoid stone spillage and intra-abdom inally retained stones. Conversion to open surgery has to be considered in the presence of adverse factors, such as primary acute cholecystitis or cho lecystitis induced by previous sphincterotomy, or bilirubinate stones belie ved to be infected. Abdominal abscess treatment requires removal of missed stones by surgical incision or new laparoscopic procedure because simple pe rcutaneous drainage is usually unsuccessful.