IS LOST STONES IN THE PERITONEAL CAVITY AFTER CHOLECYSTECTOMY HARMFUL

Abdel-Ltif Ahmed Abdel-Ltif*

ABSTRACT

Background: Gall stones disease is one of the commonest causes of abdominal pain. Cholecystectomy is the only definitive treatment for this disease which offers cure. It should be done as early as possible before the onset of complications. The management of patients with this disease has been revolutionized in the last few years with the introduction and evolution of laparoscopic cholecystectomy. With increasing skills and improvement of equipments and instruments, more complicated cases of gall stones such as acute cholecystitis are conducted through laparoscope. This attitude add to increased incidence of operative complications during laparoscopic cholecystectomy. One of these complications is laceration of gall bladder with dispersion of the stones within the peritoneal cavity with subsequent infection or adhesions. This complication occurs in 9-20% of cases. Patients and Methods: Aprospective study on 40 patients who were admitted to general surgery department in AL-Azhar assuit university hospital presented with right upper abdominal pain after laparoscopic and open cholecystectomy in the period from junuary 2016 to junuary 2017. Adult patient (above 20 yrs old) (common in old age). both sex  female and male (but female > male). Results: In this study 40 patients were complaining from Rt upper Abd. Pain after open and laparoscopic cholecystectomy, 31 patients of them (77.5%) were females and 9 patients (22.5%) were males. Age range from 20 – 60 years. Most patients were in 5th and 6th decades of life. In our study 36 of forty patients (90%) had gall bladder stones and treated by laparoscopic cholecystectomy while 4 patients had treated by open cholecystectomy, 3 patients converted from laparoscopic cholecystectomy to open cholecystectomy. In 3 patients (7.5%) were presented by night sweats right back and loin pain and right loin swelling. On examination 2 patients (female 56 years old and male 59 years old) had a tender fluctuant swelling in the right lumber region with overlying skin erythema. A computed tomography (CT) scan showed A complex subpherenic, subhepatic and subcutaneous collection. These collections were diagnosed as abscesses. These abscesses were drained under ultrasound guidance and the drains left in situ, the pus grew E-Coli (Escherichia coli) and streptococcus on culture. The 2 patients were treated with Antibiotics for ten days and discharged home. Conclusion: complications arising from spillage of gall stones during cholecystectomy are of low incidence. The surgeon should take most care to prevent spillage of stones and attempt to remove all visible stones at the time of surgery especially if they are of infected type. Conversion to open technique to retrieve the stones is not indicated.

Keywords: cholecystectomy, lost stones, subphrenic abscess.