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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 622-627
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.622
Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report
Cheng-Ken Huang, Ruey-Hwa Lu, Chien-Cheng Chen, Po-Chun Chen, Wen-Chang Hsu, Meng-Jui Tsai, Chin-Tsung Ting
Cheng-Ken Huang, Chien-Cheng Chen, Po-Chun Chen, Wen-Chang Hsu, Meng-Jui Tsai, Chin-Tsung Ting, Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
Ruey-Hwa Lu, Division of General Surgery, Department of Surgery, Zhongxing Branch, Taipei City Hospital, Taipei 103, Taiwan
Chin-Tsung Ting, School of Medicine, Institute of Traditional Medicine, National Yang-Ming University, Taipei 112, Taiwan
Chin-Tsung Ting, Department of Health and Welfare, University of Taipe, Taipe 104, Taiwan
Author contributions: Huang CK, Lu RH, and Ting CT contributed to manuscript writing and editing; Chen CC, Chen PC, Hsu WC and Tsai MJ contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cheng-Ken Huang, MD, Doctor, Surgeon, Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, No. 10, Section 4, Ren’ai Road, Da’an District, Taipei 106, Taiwan. dbb35@tpech.gov.tw
Received: November 14, 2023
Peer-review started: November 14, 2023
First decision: December 6, 2023
Revised: December 8, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: February 27, 2024
BACKGROUND
Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status. The gallstones may sometime be spilled into the peritoneal cavity, resulting in intra-abdominal abscess if the gallstones were not retrieved. The diagnosis of intra-abdominal abscess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies, such as abdominal ultrasonography or computed tomography (CT). Here we present a case of abscess formation from unretrieved gallstone following laparoscopic cholecystectomy, which mimics the imaging findings of metastatic gallbladder adenocarcinoma.
CASE SUMMARY
This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery. After adjuvant chemotherapy, the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered. Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.
CONCLUSION
Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery. For spilled gall bladder stones, surgeons may consider regular computerized tomography follow-up, and if necessary, laparoscopic examination can be used as a means of confirming the diagnostic and treatment.
Core Tip: Gallstones spillage frequently occurs during laparoscopic cholecystectomy. Surgeons should consider complete removal of spilled gallbladder stones, and follow-up with computed tomography (CT) imaging to detect abnormal nodule or abscess formation early after operation. However, CT cannot make a good differential diagnosis of abscess or malignant tumor metastasis. Laparoscopy can effectively obtain cell and tissue for the pathological diagnosis and treatment, and is a good tool for diagnosis and treatment.
