Department of Emergency and Trauma Surgery, Parma University Hospital, Parma-Italy.
Department of General Surgery, Parma University Hospital, Parma-Italy.
Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):95-103. doi: 10.14744/tjtes.2020.07280.
Thoracic complications from retained abdominal gallstones are quite rare and the incidence rate ranges between 0.08% and 0.3%. Diagnosis and treatment of these complications are challenging due to the uncommon presentations and the debated role of the thoracic approach. This review of all cases reported in literature aims to discuss the best practice of this rare condition.
A comprehensive literature search was performed for articles from January 1993 to May 2019 using PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words were used: 'cholelithopthysis', 'thoracic', 'gallstones' 'retained', and 'spilled'. All cases of thoracic complications from retained gallstones after laparoscopic cholecystectomy were extrapolated.
Twenty-four patients were included in this study. The most common symptoms were fever, hemoptysis and lithoptysis. Symptoms after laparoscopic cholecystectomy were presented after a mean time of 9.8±14.2 months (range from one week to 60 months). Delayed diagnosis was found in fourteen patients (58.4.%). Only four subjects were treated successfully with antibiotic therapy alone (16.7%), whereas 20 patients needed surgery or interventional radiology (83.3%). Seven patients (29.2%) were successfully managed with an abdominal approach. Three patients were managed using thoracentesis, thoracoscopic-thoracotomic drainage (12.5%). Right lung decortication and pulmonary wedge resections were necessary for ten patients (41.6%).
Clinicians always must inquire about the previous cholecystectomy for cholelithiasis related diseases in all patients suffering from recurrent right-sided pleural/lung affections, to improve diagnostic delay. The escalated approach must be performed: empirical antimicrobial therapy followed by targeted therapy as soon as microbiological data are available; afterwards, abdominal surgery is effective in approximately 30% of patients while the remaining patients have to be submitted to a thoracic approach.
由残留的腹部胆石引起的胸部并发症相当罕见，发病率在 0.08%至 0.3%之间。由于其表现不常见，以及胸部方法的作用存在争议，因此这些并发症的诊断和治疗具有挑战性。对文献中所有报道的病例进行回顾，旨在讨论这种罕见情况的最佳治疗方法。
使用 PubMed、MEDLINE、Embase、ScienceDirect 进行了从 1993 年 1 月至 2019 年 5 月的文献全面检索，使用了以下主题词：“胆石脱落”、“胸部”、“胆结石”、“残留”和“溢出”。提取了所有腹腔镜胆囊切除术后残留胆结石引起的胸部并发症的病例。
本研究纳入了 24 例患者。最常见的症状是发热、咯血和石咳。腹腔镜胆囊切除术后症状出现的平均时间为 9.8±14.2 个月（范围为一周至 60 个月）。14 例患者（58.4%）发现延迟诊断。仅 4 例患者（16.7%）单纯使用抗生素治疗成功，而 20 例患者需要手术或介入放射治疗（83.3%）。7 例患者（29.2%）通过腹部方法成功治疗。3 例患者通过胸腔穿刺、胸腔镜-开胸引流（12.5%）进行治疗。10 例患者（41.6%）需要进行右肺去皮质和肺楔形切除术。
对于所有患有右侧胸膜/肺部反复感染的患者，临床医生必须询问是否有胆石症相关疾病的既往胆囊切除术病史，以提高诊断延迟。必须采取升级方法：在获得微生物数据后，立即进行经验性抗菌治疗，然后进行靶向治疗；随后，腹部手术对约 30%的患者有效，而其余患者则需要进行胸部手术。
