Gallstones may be dropped inside the body during surgical removal of the gallbladder.
Gallstones -- pebble-like deposits that form in bile produced by the liver -- can cause symptoms such as abdominal pain, nausea and vomiting when they block passages between the gallbladder and other organs. The treatment of choice for gallstones that cause symptoms is surgical removal of the gallbladder, the organ that stores the bile until needed during the digestive process. If a hole opens in the gallbladder during the procedure, gallstones may be dropped or spilled into the abdomen.
More than 700,000 cholecystectomies -- operations to surgically remove the gallbladder -- are performed in the United States every year. The procedure may be performed through a single incision, called an open cholecystectomy, or by inserting long instruments through 4 small incisions, a technique called laparoscopic cholecystectomy. Dropped gallstones are more common in laparoscopic cholecystectomies because the risk of opening a hole in the gallbladder is higher. Males, obese people and those who have internal scar tissue or an inflamed gallbladder have the highest risk of dropped or spilled gallstones during cholecystectomy.
Dropped or spilled gallstones may stay in the abdominal cavity near the liver or may move to other parts of the body. Approximately 0.08 to 0.3 percent of patients develop complications from dropped or spilled gallstones. Complications may include abscesses -- pockets of pus -- in the liver, pelvis or abdomen, infection at the surgical site, bowel obstruction, infection in the chest or other problems that seem to be unrelated to the gallbladder removal.
Signs and Symptoms
Many people with dropped gallstones have no symptoms and the condition is only discovered when the gallstones are seen during ultrasound testing. If symptoms are present, their nature will depend on the location of the dropped gallstones and whether or not an infection develops. If present, symptoms may include fever, chills or pain in the abdomen, chest, pelvis or urinary tract. Symptoms tend to develop within a few months after surgery, but some appear as late as 20 years after the procedure.
Surgeons attempt to prevent dropped gallstones at the time of surgery when possible. If the gallbladder develops a hole during the procedure, the area should be flooded with sterile fluids and the gallstones should be removed by suctioning. The person having the surgery should be told about the incident, and the occurrence should be documented for future reference in case complications develop later. The treatment for complications depends on the location and size of the gallstones but often involves antibiotics, removal of the stones if possible and drainage of pus pockets.