Maempel Julian, Darmanin Geraldine, Paice Alistair, Uzkalnis Alek
Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.12.2008.1321. Epub 2009 Jun 18.
A 42-year-old woman presented to the surgical outpatient department with what appeared to be a strangulated recurrent paraumbilical hernia. She was taken to theatre, where exploration revealed an unexpected diagnosis: an abdominal wall abscess that had formed around what appeared to be a gallstone dropped at the umbilical port site of a laparoscopic cholecystectomy performed 10 years previously. The abscess was incised and drained and a connection with the abdominal cavity excluded. The patient made a full recovery. Complications relating to spilled gallstones are rare, but can present in a variety of ways and sometimes many years after the original surgery. They should always be considered in a patient with a history of cholecystectomy presenting with an abdominal wall mass. There is no clear evidence of the best imaging modalities to be used for investigation. Methods for reducing the risk of such complications and the principles of different treatments are discussed.
一名42岁女性因看似绞窄性复发性脐旁疝就诊于外科门诊。她被送往手术室，术中探查发现了一个意外诊断：腹壁脓肿，脓肿围绕着一块似乎是10年前腹腔镜胆囊切除术脐部端口处掉落的胆结石形成。脓肿被切开引流，排除了与腹腔的连通。患者完全康复。与胆结石溢出相关的并发症很少见，但可能以多种方式出现，有时在初次手术后许多年才出现。对于有胆囊切除病史且出现腹壁肿块的患者，应始终考虑到这种情况。目前尚无明确证据表明哪种最佳影像学检查方式可用于诊断。本文讨论了降低此类并发症风险的方法以及不同治疗原则。
