Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

Abstract

Background: Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status. The gallstones may sometime be spilled into the peritoneal cavity, resulting in intra-abdominal abscess if the gallstones were not retrieved. The diagnosis of intra-abdominal abscess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies, such as abdominal ultrasonography or computed tomography (CT). Here we present a case of abscess formation from unretrieved gallstone following laparoscopic cholecystectomy, which mimics the imaging findings of metastatic gallbladder adenocarcinoma.

Case summary: This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery. After adjuvant chemotherapy, the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered. Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.

Conclusion: Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery. For spilled gall bladder stones, surgeons may consider regular computerized tomography follow-up, and if necessary, laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

Keywords: Case report; Gallbladder cancer; Gallstone spillage; Laparoscopic cholecystectomy; Mimicked cancerous.

Figure 1

Cholelith-like mass with abscess on the surface of the S7 segment of the liver.

Figure 2

Suspected local recurrence or metastasis on abdominal computed tomography scan. A: August 2022; B: December 2022; C: March 2023.

Figure 3

Suspected tumor seeding via whole-body positron emission tomography.

Figure 4

Histological examination of the partial resection resection omentum. Brownish foreign body substances were present and surrounded by purulent inflammatory cells and foreign body giant cells. Brownish the brownish foreign material was stone.