432 intra-Peritoneal Gallstone Leading to Chronic Sinus Formation Following Laparoscopic Cholecystectomy and Common Bile Duct Exploration - Rare Case Report

Abstract Background Dropped gallstones can be a common occurrence during laparoscopic cholecystectomy. However, only 3% patients develop abscess secondary to intra-peritoneal spilled gallstone. We report the case of a 41-year-old woman who suffered with persistent intra-abdominal collections and sinus tract discharge following laparoscopic cholecystectomy. Case Presentation Our patient originally underwent elective laparoscopic cholecystectomy and common bile duct (CBD) exploration for CBD stones. Two weeks later, she underwent incision and drainage procedure for port site abscess. Three years later, she re-presents with right upper quadrant pain, discharge through the umbilical wound and raised inflammatory markers. Computed Tomography (CT) scan revealed a collection postero-lateral to the right lobe of the liver, which was then drained through interventional radiology. Despite drainage, patient re-attends with recurrence of pain, a repeat CT scan confirmed a persistent peri-hepatic collection likely secondary to retained intra-peritoneal gallstone. Patient underwent diagnostic laparoscopy, in which, the collection was tracked by flushing radiological drain and then the stone was retrieved. Patient recovered well. Discussion Diagnosis of an intra-peritoneal gallstone following cholecystectomy and CBD exploration can be hampered by unusual clinical presentations, radiologically occult nature of stones and the vast area they can settle into. Whilst rare, retained intra-peritoneal gallstones have the potential to cause economic burden to the health service, in addition to, the physical and psychological impact on the patient. Our case demonstrates that it is imperative to be meticulous in clearance of bile and stone spillage all cases of cholecystectomy with CBD exploration.