A Case of Intra-abdominal Abscess Around a Dropped Surgical Clip After Laparoscopic Cholecystectomy

Abstract

Loss of gallstones during laparoscopic cholecystectomy is a known cause of intra-abdominal abscess, but there have been few reported cases of an abscess forming around a dropped surgical clip. An 87-year-old man who had chronic inflammation of the gallbladder underwent laparoscopic cholecystectomy, during which the gallbladder wall was perforated and the bile leaked into the abdominal cavity. A surgical clip used to ligate the cystic duct had been dropped and remained in Morrison’s pouch. The patient presented to us 3 years after the surgery complaining of right flank pain. Computed tomography showed an abdominal abscess measuring 8.0×4.5 cm in diameter around the surgical clip in Morrison’s pouch. After percutaneous abscess drainage, the clip was surgically removed. Because no abscess in Morrison’s pouch had been observed in the early postoperative period after cholecystectomy, this late abscess was considered to have arisen from the small amount of infectious bile remaining on the clip. In laparoscopic cholecystectomy, it is important to ensure that a clip with bile sticking to it is not mistakenly left behind, but carefully extracted during surgery.