Laparoscopic cholecystectomy is the gold standard for symptomatic gallstones disease. Gallbladder perforation, usually in the dissection, is one of the most frequent intraoperative complications; however, gallstone spillage and subsequent problems are uncommon (1)

Brockmann et al. described some risk factors such as male gender, advanced age, perihepatic location, multiple stones (> 15), median size higher than 1.5 cm as well as other previously reported (infected bile and pigment stones due to bacterial contamination is higher than colesterol calculi) (1-3).

Intra-abdominal abscess is the most common lost gallstones complication reported with a median time between laparoscopic cholecystectomy and abscess of 11 months (how long do symptoms delay after initial surgery ?)

Microbiological cultures have shown that main microorganism isolated are E. coli, K. pneumoniae and E. faecalis (were microbiological cultures done in their case-report and which were species isolated ?).

Broad spectrum antibiotic therapy and drainage with stone removal seems to be the best approach. Percutaneous drainage has a high failure rate.

Currently, such as authors have described, laparoscopic conversion to laparotomy is not indicated unless gallstones massive spillage and impossible retrieval since even with laparotomy, stones may not be found. An effort should be made to retrieve gallstones and document spilled stones in operation paper (3,4)

The lost clips incidence during laparoscopic cholecystectomy is unknown. Lost clips are thought to be not harm; however, some complications have been described such as chronic abdominal pain, intra-abdominal abscess or duodenal ulcer.

This is a rare case-report not only its rarity but also its successful non-operative management.

References

(1) Castellón-Pavón C, Morales-Artero S, Martínez-Pozuelo A, Valderrábano-González S. Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica. Cir Esp 2008; 84: 3-9.

(2) Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007; 193: 73-8.

(3) Brockmann JG, Kocher T, Senninger NJ, Schurmann GM. Complications due to gallstones lost during laparoscopic cholecystectomy. Surg Endosc 2002; 16: 1226-32.

(4) Mullerat J, Cooper K, Box B, Soin B. The case for standardisation of the management of gallstones spilled and not retrieved at laparoscopic cholecystectomy. Ann R Coll Surg Engl 2008; 90: 310-2.

1.- General and Digestive Surgery formed in Hospital General Universitario Gregorio Marañón.