Viera F Torello, Armellini E, Rosa L, Ravetta V, Alessiani M, Dionigi P, Rossi S
Medicina VI, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
Abdom Imaging. 2006 Sep-Oct;31(5):564-7. doi: 10.1007/s00261-005-0241-8. Epub 2006 Jan 30.
Laparoscopic cholecystectomy (LC) is the treatment of choice for uncomplicated symptomatic gallstones. Spillage of stones due to gallbladder rupture has been reported in up to 33% of all LCs, but clinical sequelae caused by dropped gallstones are uncommon. We recently observed two patients with retained stones after LC. Correct diagnosis was made by abdominal ultrasonography (US) in both cases. In the first patient, who presented with fever, malaise, and weight loss 18 months after LC, abdominal US revealed hypoechoic focal lesions containing hyperechoic images with posterior shadowing of the liver and spleen. US-guided aspiration biopsies of these lesions yielded purulent material, and the injection and aspiration of saline solution provoked rolling movements of the hyperechoic images. Laparotomy confirmed the diagnosis of abscess-containing spilled gallstones. In the second patient, multiple hyperechoic images with posterior shadowing were observed in the Morison pouch during a routine US examination. The diagnosis of retained stones was consistent with the history of gallstone spillage during LC performed 2 months previously and was confirmed by computed tomographic findings of hyperdense images in the Morison pouch. The patient was asymptomatic, and treatment was thus deferred. Our experience suggests that US can be very useful in the detection of gallstones spilled during LC.
腹腔镜胆囊切除术(LC)是治疗无并发症的有症状胆结石的首选方法。据报道,在所有LC手术中,高达33%的病例会出现因胆囊破裂导致的结石溢出,但因掉落的胆结石引起的临床后遗症并不常见。我们最近观察到两例LC术后结石残留的患者。两例均通过腹部超声(US)做出了正确诊断。第一例患者在LC术后18个月出现发热、不适和体重减轻,腹部超声显示肝脏和脾脏有低回声局灶性病变,其中包含高回声图像并伴有后方声影。对这些病变进行超声引导下穿刺活检,获取了脓性物质,注入和抽吸生理盐水时高回声图像出现滚动。剖腹手术证实为含脓肿的溢出胆结石。第二例患者在常规超声检查时,在莫里森陷窝观察到多个伴有后方声影的高回声图像。结石残留的诊断与2个月前进行LC手术时胆结石溢出的病史相符,并通过计算机断层扫描发现莫里森陷窝内的高密度图像得以证实。该患者无症状,因此推迟了治疗。我们的经验表明,超声在检测LC术中溢出的胆结石方面非常有用。