102 Subhepatic Abscess Secondary to Dropped Gallstones

Clinical Presentation

A 42-year-old woman presents with abdominal pain and fever 10 days after laparoscopic cholecystectomy for severe gangrenous cholecystitis with a gallbladder full of stones.

Fig. 102.1 (A–C) Axial CT images with oral and intravenous contrast demonstrate cholecystectomy clips. Caudal images show a subhepatic fluid collection with rim enhancement (arrow) and surrounding fat stranding containing four radiopaque gallstones (curved arrow).

Radiologic Findings

Axial computed tomography (CT) images with oral and intravenous contrast demonstrate a subhepatic fluid collection with rim enhancement and surrounding fat stranding containing four radiopaque gallstones (Fig. 102.1).

Diagnosis

Subhepatic abscess secondary to dropped gallstones

Differential Diagnosis

Simple abscess
Tumor
Hematoma
Biloma

Discussion

Background

Spillage of gallstones during laparoscopic cholecystectomy occurs in ˜4 to 50% of cases. Complications from dropped stones are very rare and occur in only ˜0.08 to 0.30% of patients.