Spilled but Not Forgotten: A Retained Gallstone Leading to Colonic Fistula Formation

Laparoscopic cholecystectomy (LC) is a routinely performed procedure for symptomatic cholelithiasis, known for its minimal invasiveness and favorable outcomes; however, intraoperative gallbladder perforation and subsequent stone spillage can lead to rare but serious complications such as abscess formation and fistulization. A 38-year-old male patient with a history of sickle cell disease and prior LC presented multiple times with recurrent right upper quadrant (RUQ) pain and sepsis, and over the course of two years, imaging and endoscopic evaluations revealed persistent subhepatic abscesses with a fistulous tract involving the ascending colon. Intraoperative exploration ultimately uncovered a retained gallstone serving as the nidus of this chronic inflammatory process, and a laparoscopic right hemicolectomy with the removal of the stone was performed, leading to the resolution of the patient's symptoms. Although many retained gallstones remain clinically silent, a fraction present late with abscesses or fistulas, complicating diagnosis and increasing morbidity; therefore, comprehensive imaging studies, including CT scans and colonoscopy, are essential for identifying potential complications, and definitive surgical intervention is often required to remove the affected bowel segment and the offending stone. This case underscores the importance of meticulous intraoperative technique and vigilance in patients who develop unexplained or recurrent abdominal sepsis after LC, highlighting that early recognition of this rare complication can guide appropriate management and ultimately reduce the risk of severe morbidity.