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Case Reports
. 1998 Jul-Sep;2(3):285-8.

Tandem subdiaphragmatic and pleural sequelae due to lost gallstones following cholecystectomy

A Paramesh  1 , T Casale, R Peralta, T Phan, S Prakash, Y Silva
Affiliations
Case Reports

Tandem subdiaphragmatic and pleural sequelae due to lost gallstones following cholecystectomy

A Paramesh et al. JSLS. 1998 Jul-Sep.

Abstract

We report two similar thoracoabdominal complications we encountered due to retained gallstones after cholecystectomy. These patients had had an open cholecystectomy after a failed laparoscopic attempt, with spillage of gallbladder debris intraoperatively. They were admitted more than 12 months later with subdiaphragmatic abscesses. Attempted computerized axial tomography (CT) guided drainage of these abscesses resulted in these patients developing pleural fluid collections, which required surgical drainage. The patients underwent exploratory laparotomies, and drainage of the subdiaphragmatic abscesses had revealed gallstones within the abscess cavity. A detailed presentation of these cases, with review of current literature and clinicopathologic issues for discussion are described.

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Figures

Figure 1.
Figure 1.
CT scan of the abdomen from Case 1, demonstrating a large hypodense lesion over the posterosuperior aspect of the right lobe of the liver. Within this abscess, we found a single gallstone.
Figure 2.
Figure 2.
CT scan of the chest from Case 1, revealing a loculated empyema of the pleura on the right side, which developed after transthoracic CT aspiration of the Subdiaphragmatic abscess.
Figure 3.
Figure 3.
CT scan of the abdomen from Case 2, demonstrating an abscess over the superior surface of the right liver. Transthoracic CT aspiration could not be successfully performed as the abscess was multiloculated.
Figure 4.
Figure 4.
Operative photograph from Case 2, demonstrates the subdiahragmatic abscess cavity with multiple gallstones seen within.
See this image and copyright information in PMC

References

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