# When Low Back Pain Unveils an Unusual Diagnosis: Persistence of Gallstones After Cholecystectomy

## TL;DR

A rare case of persistent gallstones after gallbladder removal led to unusual symptoms and required multidisciplinary care for successful treatment.

## Contribution

This case highlights an unusual post-cholecystectomy complication involving ectopic stone drainage and emphasizes the importance of early intervention.

## Key findings

- Persistent biliary stones were confirmed as calcium oxalate following a traumatic hematoma.
- Surgical intervention resolved symptoms through partial fistulectomy and stone extraction.
- Multidisciplinary care and early diagnosis were critical for a favorable outcome.

## Abstract

Persistence of biliary stones after cholecystectomy is a rare condition that requires early diagnosis and timely intervention to prevent complications. We present the case of a 67-year-old female with a history of hypertension, dyslipidemia, and cholecystectomy (2009), who developed ectopic lithiasic drainage through a fistulous tract following a traumatic hematoma in the dorsolumbar region.

The patient experienced inflammatory signs and spontaneous drainage of stones, later confirmed as calcium oxalate. Imaging and endoscopic procedures revealed persistent biliary stones and a fistulous cavity in the hepatorenal space, leading to multiple episodes of stone expulsion and abscess drainage. Surgical intervention, including partial fistulectomy and debridement with extraction of biliary stones, resulted in symptom resolution.

This case underscores a rare post-cholecystectomy complication and highlights the importance of an integrated multidisciplinary approach involving primary and secondary care. Early intervention and longitudinal follow-up by the family physician were critical in achieving a favorable outcome.