Case Reports
Cholelithoptysis and pleural empyema

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Abstract

We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy.

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Comment

We present a case of bilioptysis and cholelithoptysis as a delayed complication of stone spillage at the time of laparoscopic cholecystectomy. Boyd in 1977 [1] described the relationship of subphrenic infection to the formation of broncho-biliary fistulas. Volume and pressure of bile accumulation cause eventual erosion through the diaphragm and secondary pleural infection. If adhesions exist between the lung and diaphragm, perforation into the bronchial system can occur with broncho-biliary

References (7)

  • D.P. Boyd

    Bronchobiliary and bronchopleural fistulas

    Ann Thorac Surg

    (1977)
  • H.D. Adams

    Pleurobiliary and bronchobiliary fistulas

    J Thorac Surg

    (1955)
  • N.J. Soper et al.

    Does intraoperative gallbladder perforation influence the early outcome of laparoscopic cholecystectomy?

    Surg Laparosc Endosc

    (1991)
There are more references available in the full text version of this article.

Cited by (20)

  • Massive hemoptysis from a lung abscess due to retained gallstones

    2001, Annals of Thoracic Surgery
    Citation Excerpt :

    Additionally, we encountered descriptions of subdiaphragmatic abscesses causing pleural effusions necessitating a chest tube or thoracotomy for drainage [3, 4]. Other authors described lost gallstones presenting with cholelithoptysis or empyema [5, 6]. In view of these increasing numbers of reports discussing the complications of retained gallstones, all efforts should be taken to avoid gallstone spillage.

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