Abdominal wall abscess containing gallstones as a late complication to laparoscopic cholecystectomy performed 17 years earlier
A 53-year-old woman presented to the surgical department with uncharacteristic rectal pain. Upon physical inspection, scars from an LC performed 17 years earlier were noted. Physical examination of the abdomen was normal, but rectal exploration revealed a 7 × 7 cm big impression profound to the anterior rectal wall 5 cm above the external sphincter.\nBesides a feeling of heaviness, incomplete defecation and rectal pain, she had no subjective complaints. Temperature at admission was 38°C (100.4°F).\nLaboratory tests at admission indicated infection with C-reactive protein of 281 mg/l, leukocytosis of 10.5 × 109/l with 7.6 × 109/l neutrophils.\nThere was no previous history of inflammatory bowel disease and a recently diagnosed type I diabetes was the only competing illness. Review of the operation notes from the LC revealed that gallstones had been left intra-abdominally since a strongly adherent gall bladder perforated during dissection from the liver bed.\nA computed tomography (CT) scan showed a 2.7 cm wide abscess in the Douglas pouch (Fig. ). Anoscopy showed no rectal communication or other anorectal pathology and the abscess was drained transvaginally. Microbiological testing was positive for Enterococcus faecalis.\nColonoscopy and gynecological examination were without abnormal findings.\nA control CT scan 3 months after the initial admission showed complete regression of the pelvic abscess. Furthermore, a 2 × 3 cm abdominal wall abscess was found behind the superior part of the right rectus abdominis muscle, equivalent to the port site where the perforated gall bladder was extracted 17 years earlier (Fig. ). Ultrasonically guided biopsy showed acute inflammation and Escherichia coli.\nThe abdominal wall abscess was excised under general anesthesia. Fibrotic tissue along with three gall concrements measuring 3–4 mm were removed.\nThe postoperative course was uneventful.