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Dropped Gall Stones | Radiology Board Review Case

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Dropped Gall Stones and Differentials of Peritoneal Deposits | Radiology Board Review Case

Incidence and pathophysiology

  • Spillage of gall stones in the peritoneal cavity causes “dropped” gall stones or retained gall stones.
  • These are common with laparoscopic cholecystectomies, reported in up to 7 percent cases.
  • Can act as an inflammatory nidus, especially pigment gall stones.
  • Can migrate and lie outside the peritoneal cavity.
  • Complications:
    • Abscesses – Most commonly at the abdominal port sites and the perihepatic spaces.
    • Fistulas
    • Others.

Imaging features

  • Location: Perihepatic spaces and pelvis
  • CT – Small iso to hypodense nodular lesions. Stones with calcium content will appear hyperdense.
  • MRI – Non-enhancing T1 hyperintense foci.
  • Look for interval stability and history of laproscopic cholecystectomy.
  • Often confused with peritoneal deposits as in the case illustrated above.
  • Differentials include peritoneal metastasis, colonic diverticula, dropped appendicolith and peritoneal loose bodies AKA “peritoneal mice” (chronic torsion and auto-amputation of epiploic appendages causes these benign soft tissue nodules in the peritoneal cavity).

Management

Drainage of abscess and removal of all gall-stones. This can be usually be achieved by percutaneous drainage, if unsuccessful laparoscopy can be performed.

Differentials diagnosis of peritoneal nodules

  • Peritoneal carcinomatosis
  • Primary peritoneal mesothelioma
  • Peritoneal tuberculosis
  • Lymphoma
  • Dropped gall-stones
  • Splenosis
  • Primary peritoneal mesothelioma

Reference and further reading

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