A case of intra-abdominal abscess formed by spilled gallstone during laparoscopic cholecystectomy for acute cholecystitis which penetrated into the ascending colon

Abstract

A 67-year-old man underwent laparoscopic cholecystectomy for acute cholecystitis. On the 15th postoperative day, CT scan revealed an intra-abdominal mass on the ventral side of the ascending colon. Four months later, the mass increased in size. Needle biopsy revealed xanthogranulomatous inflammation (XGI). Two months later, CT showed the mass had further increased in size and the boundary between the mass and nearby organs was unclear. In laparotomy, it was suggested the mass invaded the ascending colon, abdominal wall, and omentum, therefore right hemicolectomy with combined resection of these organs was performed. Abscess and a small stone were inside the mass, and had penetrated into the ascending colon. Analysis of the stone revealed that it was derived from bile. Histopathological examination indicated the abscess formation with XGI resulted from the spilled gallstone. This is the first report of a penetration of abscess formed by spilled gallstone into the intestine.