Minimally Invasive Approach after Lumbar Abscess Secondary to Retained Gallstones in Abdominal Cavity after Laparoscopic Cholecystectomy

Abstract

Introduction:

Laparoscopic cholecystectomy is widely performed and safe, but may present rare complications such as retained gallstones (“dropped gallstones”), which can act as a nidus for infection and cause late intra-abdominal or retroperitoneal abscesses.

Methods:

A 40-year-old male with prior laparoscopic cholecystectomy presented with fever and right lumbar pain. Examination showed an inflammatory lumbar mass with leukocytosis and elevated C-reactive protein. Imaging revealed a right paravertebral collection with a fistulous tract to the abdominal cavity. Despite antibiotics and percutaneous drainage, recurrence occurred. Surgical lumbotomy revealed multiple gallstones, confirming the etiology, with subsequent clinical improvement.

Results:

Retained gallstones may migrate, act as foreign bodies, and cause recurrent infection. Magnetic resonance imaging was key to identifying the abdominal origin, and surgical stone removal was required for definitive treatment.

Conclusion:

Lumbar abscesses in patients with previous cholecystectomy should raise suspicion of retained gallstones. Definitive management requires drainage and complete stone removal to prevent recurrence.