Article Text

Unexpected outcome (positive or negative) including adverse drug reactions
An unusual “hernia”: losing a stone is not always a good thing!
  1. Julian Maempel1,
  2. Geraldine Darmanin2,
  3. Alistair Paice3,
  4. Alek Uzkalnis4
  1. 1
    Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, UK
  2. 2
    King’s College Hospital, Denmark Hill, London, Greater London, SE5 9RS, UK
  3. 3
    Maidstone and Tunbridge Wells NHS Trust, Department of General Surgery, Hermitage Lane, Maidstone, ME16 9QQ, UK
  4. 4
    University Hospital Lewisham, Lewisham High Street, London, SE13 6LH, UK
  1. Julian Frederick Maempel, julian.maempel{at}gmail.com

Summary

A 42-year-old woman presented to the surgical outpatient department with what appeared to be a strangulated recurrent paraumbilical hernia. She was taken to theatre, where exploration revealed an unexpected diagnosis: an abdominal wall abscess that had formed around what appeared to be a gallstone dropped at the umbilical port site of a laparoscopic cholecystectomy performed 10 years previously. The abscess was incised and drained and a connection with the abdominal cavity excluded. The patient made a full recovery. Complications relating to spilled gallstones are rare, but can present in a variety of ways and sometimes many years after the original surgery. They should always be considered in a patient with a history of cholecystectomy presenting with an abdominal wall mass. There is no clear evidence of the best imaging modalities to be used for investigation. Methods for reducing the risk of such complications and the principles of different treatments are discussed.

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Footnotes

  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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