An unusual site of gallstones five years after laparoscopic cholecystectomy.

INTRODUCTION: Gallstone spillage during laparoscopic cholecystectomy is a common occurrence. Complications due to spilled gallstones occur in up to 5% of laparoscopic cholecystectomy cases, with complications having been reported up to 20 years after laparoscopic cholecystectomy.

CASE REPORT: We report the case of a 70 year old male who presented for elective right inguinal hernia repair. At the time of repair he was found to have multiple foreign bodies embedded within an indirect hernia sac. Subsequent pathology confirmed these to be gallstones, having been spilled during emergency laparoscopic cholecystectomy 5 years prior.

DISCUSSION: Gallbladder perforation and gallstone spillage during laparoscopic cholecystectomy occurs frequently, complications due to spilled gallstones are estimated to occur in less than 5% of cases. The most common complications is abscess formation and infection. Though spilled gallstones have been implicated in the formation of colocutaneous, colovesical, and biliocutaneous fistulae. Following gallbladder perforation during cholecystectomy, closure of the hole should be attempted with laparoscopic graspers, surgical clips, or a laparoscopic ligature. Meticulous collection of all visible spilled gallstones should then take place, followed by intraperitoneal lavage ensuring care is taken not to disperse gallstones throughout the peritoneal cavity.

CONCLUSION: Gallbladder perforation during in laparoscopic cholecystectomy is common. Prevention of gallstone spillage, and retrieval of spilled gallstones is essential in minimising the risk of complications due to spillage.