INTRODUCTION F OLLOWING THE INTRODUCTION OF laparoscopic chole- cystectomy in 1987, the number of cholecystectomies performed for symptomatic biliary tract disease increased dramatically. Although several studies demonstrate sim- ilar outcomes for laparoscopic cholecystectomyand open cholecystectomy, intrinsic complications are associated with the laparoscopictechnique. 1 One of those technique- specific complications is spilled gallstones and the vari- ous clinical presentations thereof. The primary care physician should become familiar with the variable man- ifestations of this clinical problem to be able to diagnose, treat, or refer to a surgeon appropriately. A literature search was performed in MEDLINE with the keywords “spilled gallstones” and “dropped gall- stones.” Since 1963, 127 case reports of complications secondary to dropped gallstones have appeared in the lit- erature (Table 1). This report discusses the case of a woman with retained gallstones who presented with a right flank abscess. CASE REPORT A 77-year-old white woman was admitted with inter- mittent fever, anorexia, weight loss, and a right flank mass. Her temperature was 38.3°C and her white cell count 8800/mm 3 . The patient’s past medical history was significant for autoimmune hepatitis, cirrhosis, hypothy- roidism, and peptic ulcer disease. The past surgical his- tory included an appendectomy and a laparoscopic chole- cystectomy, for acute cholecystitis, 15 months before presentation.Computedtomography(CT) was performed and revealed an inflammatory right flank mass with cal- cifications and gas (Fig. 1). A percutaneous drainage catheter was placed into the mass and drained 30 mL of pus. Bacteriologic cultures of the fluid grew Klebsiella, JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 12, Number 5, 2002 © Mary Ann Liebert, Inc. Case Report Spilled Gallstones after Laparoscopic Cholecystectomy PAVLOS K. PAPASAVAS, M.D., PHILIP F. CAUSHAJ, M.D., and DANIEL J. GAGNÉ, M.D. ABSTRACT Spilled gallstones have emerged as a new issue in the era of laparoscopic cholecystectomy. We treated a 77-year-old woman who underwent laparoscopic cholecystectomy. Subsequently, a right flank ab- scess developed. During the cholecystectomy, the gallbladder was perforated and stones were spilled. After a failed attempt to drain the abscess percutaneously, the patient required open drainage, which revealed retained gallstones in the right flank. The abscess resolved, although the patient continued to have intermittent drainage without evidence of sepsis. Review of the literature revealed 127 cases of spilled gallstones, of which 44.1% presented with intraperitoneal abscess, 18.1% with abdominal wall abscess, 11.8% with thoracic abscess, 10.2% with retroperitoneal abscess, and the rest with various clinical pictures. In case of gallstone spillage during laparoscopic cholecystectomy, every ef- fort should be made to locate and retrieve the stones. Temple University Clinical Campus at The Western Pennsylvania Hospital, Department of Surgery, Pittsburgh, Pennsylvania. 383