Gastric Remnant Fistula due to Gallstone Abscess Diagnosed 12 Years After Laparoscopic Cholecystectomy: Clinical and Pathologic Characteristics of a Rare Case

Background: Laparoscopic cholecystectomy ranks among the five most common surgical procedures performed in the United States. Studies show the frequency of gallstone spillage during laparoscopic cholecystectomy ranges from 5.7% to 36%, with 0.3% of these cases resulting in abscess formation. To our knowledge, we report the only documented case of a patient who had their gastric remnant fistulized to the anterior abdominal wall from a gallstone abscess found 12 years after routine laparoscopic cholecystectomy. Case: We report a case of 39-year-old female who was found to have a gallstone abscess that resulted in a fistula of her remnant stomach to her anterior abdominal wall. Initial workup of her epigastric pain was attributed to her chronic pain and marginal ulcers found on endoscopy. However, further investigation revealed her ongoing symptoms were due to a gallstone abscess. She had prompt resolution of her symptoms after the true etiology of her problem was recognized and treated. Conclusions: Although rare, gallstone abscesses can pose a diagnostic challenge for physicians and result in significant morbidity for patients. Clinical examination yields few clues, and without a high clinical suspicion, radiographic imaging is largely nondiagnostic. Below we review the literature on spilled gallstones, recommended treatment, and discuss the workup to allow for prompt and accurate diagnosis.