CONSEQUENCES OF LOST GALLSTONE

Laparoscopic cholecystectomy has become the treatment of choice in the management of calculus gallbladder disease. Intraperitoneal gallstone lass is not uncommon; it occurs in up to 40% of cases. Often, the sto nes are left unretrieved and are thought to be inconsequential. We pre sent a series of patients who have had serious sequela From gallstones in the peritoneal cavity. We performed a retrospective study of the m anagement of six patients with complications from intraperitoneal gall stones. The patients presented with a variety of complaints, from feve rs to pneumonia to a colo-cutaneous fistula. Presentation ranged from immediately postoperatively to 18 months after surgery. Diagnosis incl uded perihepatic abscesses and colo-biliary fistula. General anesthesi a was usually necessary for removal of the stones. All patients have r esolved following the removal of the gallstones. Our recommendation is to attempt to avoid spillage through careful dissection and retrieve any lost stones. The defect in the gallbladder can be closed with a cl ip. Whether the procedure should be converted to an open one to retrie ve all the stones remains open to debate. The surgeon should be aware of the possible consequences of the lost gallstone.