Hospital: Hospital Universitario Marqués de Valdecilla.
Nº: C2019-81
Aut@r o Autores: C. González-Carreró Sixto, M.E. Peña Gómez, M.A. Ballesteros Sanz, L. Sánchez Moreno, A.A. Cardín Pereda, J. Azcona Saenz.
Presentación
-year-old woman with a history of complicated laparoscopic cholecystectomy, presented with massive hemoptysis five months later caused by a migrated gallstone. Computed tomography (CT) scan of the chest revealed a right lower lobe hemorrhage with a foreig
Discusión
Laparoscopic cholecystectomy (LC) is one of the most commonly performed procedures in general surgery. Some complications such as biliary tract injuries and intraoperative spillage of stones are more common in LC. These “lost” gallstones may cause complications even years after the procedure. The risk of their occurrence increase when gallstones are not retrieved successfully. The most common complications arise from the peritoneal cavity, which may present in the form of intraabdominal abscesses with or without transabdominal fistulas. Thoracic complications associated with dropped gallstones are rare and include empyema, hemoptysis, and cholelithoptysis. These rare complications sometimes require surgery but not all presentations of thoracic gallstones mandate operative intervention.
Conclusión
Complication arising from "lost" gallstones pose a diagnostic challenge. Even when thoracic complications are rare, if patients present with prolonged chest symptoms after undergoing biliary operations, mostly in the right hemithorax, clinical suspicion of gallstone migration should raise. Because of these potential complications, when spillage of gallstones occur during a LC reasonably efforts for recovery should be performed. For postoperative considerations, evidence of gallbladder perforation or unretrieved stones must be recorded in operative notes, and patients should be aware of the possible complications in future.
Bibliografía
? Fontaine JP, Issa RA, Yantiss RK, Podbielski FJ, et al. Intrathoracic Gallstones: a Case Report and Literature Review, Journal of the Society of Laparoscopic Surgeons, 2006 Jul-Sep,10(3):375-8. ? Quail JF, Soballe PW and Gramins DL. Thoracic Gallstones: A Delayed Complication of Laparoscopic Cholecystectomy. Surgical Infections, 2014, 15(1): 69-71.