Thoracic empyema after gallstone spillage in times of Covid

• Published in: International journal of surgery case reports 2020-01, Vol.76, p.221-226
• Main Authors: Tchercansky, Ariel Nicolas, Fernandez Alberti, Joaquin, Panzardi, Nicolas, Auvieux, Rodolfo, Buero, Agustin
• Format: Article
• Language: English
• Subjects: Case Report; Laparoscopic cholecystectomy; Spilled gallstones; Thoracic complications
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.09.181

•Thoracic complications after spilled gallstones are rare.•Thoracic consequences should be considered in every patient with thoracic symptoms and history of cholecystectomy.•Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients.•Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment. Laparoscopic cholecystectomy has become the gold standard for gallbladder disease. Although gallbladder perforation and spilled gallstones during surgery are common complications, thoracic consequences are rare. We describe a case of a pleural empyema developed in an immunosuppressed patient five months after laparoscopic cholecystectomy, as a result of spilled gallstones. Decortication via video assisted thoracoscopy resulted in retrieval of stone remnants, biliary sludge and diagnosis of a diaphragmatic defect. Iatrogenic perforation of the gallbladder is the most common complication after laparoscopic cholecystectomy. Despite this, thoracic consequences derived from spilled gallstones are rare, but they represent significant morbidity. Thoracic complications after spilled gallstones are rare. Documentation of iatrogenic perforation of the gallbladder and a high index of suspicious are fundamental to speed diagnosis and treatment.