Retained gallstone as a rare cause of recurrent fistula in the scar after laparoscopic cholecystectomy
Authors:
M. Škrabal 1; V. Pěkný 2; J. Bělehrádek 2; A. Polcar 2
Authors‘ workplace:
Klinika transplantační, chirurgie, Institut klinické, a experimentální medicíny, Praha
1; Chirurgické oddělení, Nemocnice Havlíčkův Brod
2
Published in:
Rozhl. Chir., 2025, roč. 104, č. 2, s. 76-81.
Category:
Case Report
doi:
https://doi.org/10.48095/ccrvch202576
Overview
Introduction: Cholecystectomy is one of the most common operations in surgical departments. Complications after gallbladder removal are mainly bleeding, infection including abscess in the gallbladder bed or in the abdominal wall, wound dehiscence, acute pancreatitis or injury of the bile ducts. In the further course, hernias in the scar may appear after both laparoscopic and open cholecystectomy, strictures of the bile ducts and symptoms of the so-called postcholecystectomy syndrome. The presence of residual gallstones is rare, statistically reported in 0.08–0.3%.
Case report: The goal of our message is to present the case of a patient taken into our care 7 years after laparoscopic cholecystectomy indicated for cholecystitis with wedged lithiasis in the gallbladder neck, proven by ultrasound. In our department, the patient was treated for a re-current fistula in the scar of the right subcostal area. Definitive healing from the initial manifestation of the fistula occurred despite repeated revisions after the precise localization and removal of the retained gallstone.
Conclusion: Thanks to the use of an extensive spectrum of diagnostic methods and at the same time thinking about the rare causes of a recurrent purulent collection with a fistula, we purposefully searched for an infectious source. Only perioperative radiography with injection of contrast material identified the presence of a retained gallstone. It was possible to extirpate it from the space between the intercostal muscles and the peritoneum, thereby relieving the patient of her problems.
Keywords:
abscess – fistula – cholecystectomy – fistulography – gall stones
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MUDr. Martin Škrabal
Klinika transplantační chirurgie
Institut klinické a experimentální medicíny
Vídeňská 1958
140 00 Praha
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2025 Issue 2
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