Spilled Gallstones after Laparoscopic Cholecystectomy with Complications of Subphrenic and Subhepatic Abscesses: Report of One Case Spilled Gallstones after Laparoscopic Cholecystectomy with Complicat

腹腔鏡膽囊切除術後膽結石溢出併發橫膈膜下及肝下膿瘍：一病例報告

陳俊欽(Chun-Chin Chen) ； 陳瑞灝(Jui-Hao Chen) ； 楊國卿(Kuo-Ching Yang) ； 周燕輝(Yenn-Hwei Chou)

《中華民國消化系醫學雜誌》 14卷1期 (1997/03) Pp. 37-42

https://doi.org/10.6557/GJTb.199703_14(1).0006

摘要

溢出性膽結石是腹腔鏡膽囊切除術併發症中一項常見的問題，其發生率約10-40%，但因此而造成臨床症狀則尚屬少見。在此我們報告一位肝硬化的病例一腹腔鏡膽囊切除術後10個月併發橫膈膜下及肝下膿瘍，並導致敗血症及部份大腸阻塞症狀。超音波及電腦斷層檢查可見膿瘍旁之結石。病人在抗生素治療及多次超音波定位膿液抽取下，臨床症狀及膿瘍約無法完全緩解。於是病人接受外科探查，並取出二顆黑色色素性膽結石。術後，病人完全康復。我們建議，溢出性膽結石應儘可能取出以防止此一後遺症的發生。

關鍵字

腹腔鏡膽囊切除術 ； 溢出性膽結石 ； 橫膈膜下膿瘍 ； 肝下膿瘍

並列摘要

Many complications following laparoscopic cholecystectomy have been reported. Spilled gallstones after laparoscopic cholecystectomy is a common problem with an incidence of about 10-40% of procedures. But morbidity caused by spilled gall stones is uncommon. Herein, we report a case of liver cirrhosis with the presentations of sepsis and partial colon obstruction due to delayed subphrenic and suhhepatic abscesses caused by spilled gallstones from a laparoscopic cholecystectomy 10 months earlier. The presence of incorporated stones in these abscesses was established by abdominal sonography and computed-tomography (CT). These abscesses, clinical sepsis, and partial colon obstruction were not resolved completely despite aggressive antibiotics and repeated abscess aspiration under echo guide. Surgical intervention was performed later and two small black pigment stones were retrieved and open drainage of the abscesses was done. The patient then made an uneventful recovery. Complications of spilled gallstones is discussed. We recommend that infected spilled gallstones should be removed when possible and that physicians should be aware of these possible complications.

並列關鍵字

laparoscopic cholecystectomy ； spilled gallstones ； subphrenic abscess ； subhepatic abscess