Batın ön duvarında dev safra taşı; nadir laparoskopik kolesistektomi komplikasyonu

Yıl 2013, Cilt: 19 Sayı: 1, 43 - 45, 01.02.2013

Cengizhan Yiğitler Kazım Duman Ali Özcan

Öz

We aim to report a case of abdominal wall mass formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy (LC). A 73-year-old women presented with purulent discharge from one of her previous port sites one year after she underwent LC. The latter revealed a round opaque mass in an abscess like cavity, and subsequently an ultrasonography showed a round echogenity with acoustic shadow posteriorly. Axial CT images verified the presence of a well-circumscribed hyperdensity which was really a gallstone in a cystic mass. To reduce this complication, excessive traction of the gallbladder should be avoided during dissection. Prior to extraction, gallbladder contents should be aspirated, and to extract larger stones. In the event of perforation occurring, the gallbladder should be placed in a plastic bag, spilled stones should be retrieved where possible and excessive irrigation used to remove the bile.

Anahtar Kelimeler

Abdominal wall; gallstones; laparoscopic cholecystectomy.

Giant gallstone in abdominal wall: a rare complication of laparoscopic cholecystectomy

Öz

Laparoskopik kolesistektomi postoperatif komplikasyonları oldukça çeşitlidir. Bu vakada amacımız, perfore safra kesesinin ekstrakte edilirken, dökülen safra taşının batın ön duvarında kalması ve burada kitle formasyonu göstermesinin sunulmasıdır. 73 yaşında bayan bir hastanın, Laparoskopik kolesistektomi ameliyatından yaklaşık 1 yıl sonra port yerinden pürülan akıntı, şişlik şikâyetleriyle müracaat etmesi sonucu hastaya yapılan Batın tomografisi ve ultrasonografisinde; cilt altında rektus kası önünde taş ekojenitesinin gözlenmiştir. Hasta operasyona alınmış ve taş ekstrakte edilmiştir. Sonuç olarak; Laparoskopik kolesistektomi olguları uzun dönem takip edilmeli, safra kesesi karaciğer yatağından son derece nazik diseke edilmeli, batın dışına alınırken endoskopik torba kullanılmalıdır.

Anahtar Kelimeler

Abdominal duvar; laparoskopik kolesistektomi; safra taşı.

Kaynakça

• 1. Castellón-Pavón CJ, Morales-Areno S, Marthez-Pozuelo A, Valderrábano-Gonzáles S. Complications due to spilled gallstones and surgical clips during laparoscopic cholecystectomy. Cir Esp 2008;84(1):3-9.
• 2. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165(1):9-14.
• 3. Papasavas PK, Caushaj PF, Gagne DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2002;12(5):383-6.
• 4. Werber YB, Wright CD. Massive hemoptysis from a lung abscess due to retained gallstones. Ann Thorac Surg 2001;72(1):278-9.
• 5. Yerdel MA, Alacayir I, Malkoc U, Baba F, Erverdi N, Pak I, et al. The fate of intraperitoneally retained gallstones with different morphologic and microbiologic characteristics: an experimental study. J Laparoendosc Adv Surg Tech Part A 1997;7(2):87-94.
• 6. Schafer M, Suter C, Klaiber C, Wehrli H, Frei E, Krahenbühl L. Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 1998;12(4):305-9.
• 7. Shocket E. Abdominal abscess from gallstones spilled at laparoscopic cholecystectomy. Case report and review of the literature. Surg Endosc 1995;9(3):344–7.
• 8. Crist DW, Gadacz TR. Complications of laparoscopic surgery. Surg Clin North Am 1993;73(2):265–89.
• 9. Brockmann JG, Kocher T, Senninger NJ, Schurmann GM. Complications due to gallstones lost during laparoscopic cholecystectomy. Surg Endosc 2002;16(8):1226-32.
• 10. Diez J, Arozamena C, Gutierrez L, Bracco J, Mon A, Sanchez Almeyra R, et al. Lost stones during laparoscopic cholecystectomy. HPB Surg 1998;11(2):105-8.
• 11. Welch N, Hinder RA, Fitzgibbons RJ Jr, Rouse JW. Gallstones in the peritoneal cavity. A clinical and experimental study. Surg Laparosc Endosc 1991;1(4):246-7.
• 12. Zisman A, Loshkov G, Negri M, Herbert M, Halpern Z, Lin G, et al. The fate of long-standing intraperitoneal gallstone in the rat. Surg Endosc 1995;9(5):509-11.