EDITOR'S QUIZ: GI SNAPSHOT
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| The first 150 words of the full text of this article appear below. |
From question on page 160
The diagnosis is spontaneous intraperitoneal gallstone spillage. Abdominal computed tomography showed a 1.2 cm calcified stone in the subhepatic space with mild inflammation (fig 2). Laparotomy confirmed the diagnosis of a spilled gallstone with local abscess formation (fig 3). Pathological examination of the removed gallbladder disclosed chronic cholecystitis. The patient’s symptom was relieved and there was no recurrent pain over a 6 month follow-up period.
Symptomatic gallstone diseases include biliary colic, acute cholecystitis and chronic cholecystitis. Less often, acute cholecystitis may proceed to perforation, of which three clinical types have been recognised: (a) acute perforation with bile peritonitis, (b) subacute perforation with pericholecystic abscess and (c) chronic perforation with cholecystenteric fistula formation. A spilled gallstone in the peritoneal cavity is a recognised complication of laparoscopic cholecystectomy, with a reported rate of 3–33%. Intraperitoneal gallstone spillage may cause localised or systemic infection, inflammation, fibrosis, adhesion, cutaneous
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