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Gretschel S, Engelmann C, Estevez-Schwarz L, et al. Wolf in sheep's clothing: spilled gallstones can cause severe complications after endoscopic surgery. Surg Endosc. 2001;15(1):98doi: 10.1007/s004640040035.
Gretschel, S., Engelmann, C., Estevez-Schwarz, L., & Schlag, P. M. (2001). Wolf in sheep's clothing: spilled gallstones can cause severe complications after endoscopic surgery. Surgical endoscopy, 15(1), 98. https://doi.org/10.1007/s004640040035
Gretschel, S., et al. "Wolf in sheep's clothing: spilled gallstones can cause severe complications after endoscopic surgery." Surgical endoscopy vol. 15,1 (2001): 98. doi: https://doi.org/10.1007/s004640040035
Gretschel S, Engelmann C, Estevez-Schwarz L, Schlag PM. Wolf in sheep's clothing: spilled gallstones can cause severe complications after endoscopic surgery. Surg Endosc. 2001 Jan;15(1):98. doi: 10.1007/s004640040035. PMID: 11285539.
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Surg Endosc. 2001 Jan;15(1):98. doi: 10.1007/s004640040035.

Wolf in sheep's clothing: spilled gallstones can cause severe complications after endoscopic surgery.

Surgical endoscopy

S. Gretschel, C. Engelmann, L. Estevez-Schwarz, P.M. Schlag

Affiliations

  1. Department of Surgery and Surgical Oncology, Robert Rössle Hospital, Humboldt University, Lindenbergerweg 80, D-13122 Berlin, Germany.

PMID: 11285539 DOI: 10.1007/s004640040035

Abstract

Bile concrements may remain intraperitoneally after laparoscopic cholecystectomy. Previously, this was considered harmless, a view supported by some experimental studies. Recently, however, spilled gallstones have been identified as a source of rare but potentially serious complications. We report a case of a retrohepatic abscess and dorsal fistulation after laparoscopic cholecystectomy. Healing was achieved only by repeated surgery, including abscess drainage, stone removals, and fistula excision. Since 1990, 73 cases with gallstone-related complications after laparoscopic cholecystectomy have been reported in the literature. Among these complications, intra-abdominal abscesses and transabdominal fistulas were predominant. The interval between the cholecystectomy and the appearance of complications ranged from 4 days to 29 months, with a peak incidence at 4 months. Spillage of small bile concrements or fragments is, with the exception of multiple irremovable stones, not commonly an indication for conversion to an open procedure. However, the patient needs to be warned about the risk of gallstone loss and its associated complications at the time when informed consent is obtained. Furthermore, if gallstone loss has occurred, the patient should be informed, and the occurrence should be documented.

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