Spilled gallstone mimicking right middle lobe pulmonary nodule

Abstract

Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2-20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.

Keywords: Gallstone ectopia; Gallstone migration; Intrathoracic gallstone; Laparoscopic cholecystectomy; Solitary lung nodule.

Figure 1

Computed tomography scan of the abdomen, showing an inflamed gallbladder with a 2.5cm gallstone before cholecystectomy

Figure 2

(a) Chest x-ray showing opacity in the right middle zone. (b) Computed tomography scan showing the gallstone in the right middle lobe.

Figure 3

(a) Intraoperative photograph showing healed defect in the diaphragm (arrow). (b) and (c) excised lobe, showing gallstone.