We experienced a case of abdominal abscess caused by missed gallstones during laparoscopic cholecystectomy.
A 59-year-old man underwent a laparoscopic cholecystectomy and choledocholithotomy for gallstones, acute cholecystitis and choledocholithiasis. During the operation the gallbladder wall was injured and gallstones were missed into the abdominal cavity. But the postoperative course was uneventful and the patient was discharged from the hospital. On the fifth month after the operation the patient was admitted to the hospital because of a right lateral abdominal pain, weight loss, and slight fever. An abdominal abscess on the dorsal side of the right hepatic lobe and two stones in the abscess were confirmed. Symptomatic remission was attained by percutaneous puncture of the abscess. However, on the tenth month after the operation abdominal abscess recurred. Once the abscess improved by transcutaneous drainage, but recurred again. Under general anesthesia drainage of the abscess and removal of the stones were performed. Postoperative course was uneventful. There has been no sign recurrence up to now.
It is important for perfoming laparoscopic cholecystectomy to prevent not to miss stones. Since in very few cases of missed stones reoperation has been required, we think we need not change to laparotomy to remove the missed stones when stones were missed during the operation.