Delayed duodenal/gastric fistula resulting in persistent perihepatic abscesses as a late complication of laparoscopic cholecystectomy

TL;DR

This paper describes rare late complications of laparoscopic cholecystectomy, including delayed abscesses and fistulas caused by retained gallstones.

Contribution

The paper presents two case reports highlighting the rare long-term risk of perihepatic abscesses and fistulas following laparoscopic cholecystectomy.

Findings

Delayed perihepatic abscesses can develop months to years after laparoscopic cholecystectomy.

Enteric fistulae may form as a complication of retained gallstones following the procedure.

Systematic management is required for successful treatment of these complications.

Abstract

Since the early 1990’s, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs.

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