Abstract
A 74-year-old man was admitted to our hospital because of gallbladder stone, common bile duct stone, and acute cholangitis. Following endoscopic papillotomy for common bile duct stone, laparoscopic cholecystectomy was performed. During the surgery, we confirmed a spilled stone in the abdominal cavity and recovered it by a forceps. After the surgery, the patient had persistent fever and abdominal pain. Abdominal CT scan performed on the third postoperative day revealed massive free air and inflammatory hypertrophy of the duodenum. Intestinal perforation caused by intraoperative manipulation was likely, and emergency operation was done on the same day. Operative findings included pyemic ascites and inflammatory change mainly affecting the gallbladder bed, but no demonstrable perforated site was seen in the gut. Only lavage and drainage were performed. After the operation inflammatory reaction persisted. Abdominal CT scan revealed an image of a stone and abscess formation at the inferior surface of the liver. Conservative therapy was successful and the patient was discharged from our hospital on the 43rd postoperative day. The patient had been followed in the clinic until around four months after the initial operation, when a tumor appeared at the right region of back. Abdominal CT scan revealed an abscess in the abdominal wall continued from the inferior surface of the liver and high signal areas suggestive of stones in the subcutaneous structure. On the same day we performed incision and drainage for the abscess and removed a total of four stones 5 mm in diameter from the surgical wound. Thereafter abdominal CT scan disclosed no stones. The postoperative course was satisfactory and the patient was discharged.
