A CURIOUS CASE OF RETAINED GALLSTONE

Abstract

Laparoscopy has become the first choice for cholecystectomy these days. Considering all the benefits of this choice like lesser post-op pain and post-op morbidity, shorter hospital stay [1], it also brings some complications to the table like CO2 narcosis, post-op shoulder tip pain, iatrogenic gall bladder perforation in one-third patients [2]. Perforation may cause spillage of gall bladder contents like sludge and stones. The latter ‘dropped’ stones are retrieved in all but two-third cases and complications can arise years later if not retrieved [3]. Though the incidence of these complications is low, effort should be taken to retrieve the spilled stone as they can result in a variety of problems [4]. These include abdominal abscess or a fistula formation. Abdominal abscesses may present with fever, abdominal pain and are most frequently located near the liver [5]. Abscesses are much more common than fistulas in these cases.

We report a case of a 30 year old female who presented with pain in abdomen while passing urine since 3 months. Patient had an operative history of laparoscopic cholecystectomy 2 years ago. She developed similar symptoms to what she has now one year ago which was diagnosed and treated as a UTI at the time. With no relief of symptoms, a USG and a CT were done which were suggestive of a mass thick walled soft tissue lesion with central abscess/necrosis/ haemorrhage abutting the superior wall of bladder. On excision biopsy this mass showed xanthogranulomatous and foreign body reaction to biliary material with small micro-abscesses. Patient was apparently alright after mass excision till 3 months ago when she again developed similar symptoms and with ascites. Two CT scans and an MRI later which were all insignificant, we did a diagnostic laparoscopy to find something interesting hiding from all the radiological investigations.