Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report

Abstract

Background: Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC.

Case presentation: We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up.

Conclusions: We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.

Keywords: Acute cholecystitis; Dropped gallstone; Laparoscopic cholecystectomy; Pleural empyema.

Fig. 1

CT scan and gallbladder of initial surgery. Abdominal CT performed at the time of diagnosis of cholecystitis shows marked gallbladder swelling and intramural abscess, with gallstones (arrowhead): a axial and b coronal views. c Laparoscopic cholecystectomy for acute cholecystitis. Iatrogenic perforation of the gallbladder due to the pus drainage. d Gallstones and gallbladder with wall thickening and mucosal necrosis

Fig. 2

Chest radiography and CT at the time of pleural empyema diagnosis. a Chest radiography reveals a large amount of right pleural effusion. b Chest CT shows a large amount of right pleural effusion with passive atelectasis. c, d Abdominal CT shows perihepatic fluid collection (arrowhead) and multiple small radiopaque density masses (arrow)

Fig. 3

Thoracotomy and laparotomy for drainage. a, b The abscess in the Morrison's fossa was opened (arrowhead). c Retrieved gallstones. d Decortication via video-assisted thoracoscopy. No fistula connecting to the abdominal cavity was found