{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T08:14:16Z","timestamp":1783671256480,"version":"3.55.0"},"update-to":[{"DOI":"10.12688\/f1000research.9490.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000}},{"DOI":"10.12688\/f1000research.9490.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000}}],"reference-count":9,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Abstract Introduction Perforation of the gallbladder is a benign and common complication during laparoscopic cholecystectomy. However, it may result in stone spilling, which potentially can lead to serious postoperative complications. Case report A 70-year-old male underwent laparoscopic cholecystectomy for acute cholecystitis. The procedure was complicated by perforation of the gallbladder and spilling of gallstones. More than a year after the procedure, the patient developed subcutaneous abscesses containing some of the spilled stones, a computed tomography revealed a complex intraabdominal and intrathoracic fistula with communication from the abdominal cavity to pleura and ultrasonic imaging found a lost gallstone in the thorax. After two years, the patient developed pleural empyema and sepsis secondary to the condition. Presently, the patient awaits surgery for the fistula and empyema. Conclusion Proper care should be taken to avoid stone spilling during laparoscopic cholecystectomy. However, if perforation and stone spilling occur, all visible stones should be removed during the procedure and the complication should be noted in the medical records. Furthermore, the patient should be thoroughly informed. This may help accelerate diagnosis if the patient later suffers from a complication related to lost stones.<\/ns5:p>","DOI":"10.12688\/f1000research.9490.3","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T07:29:09Z","timestamp":1783668549000},"page":"2322","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Multiple complications after laparoscopic cholecystectomy with perforation and spilled gallstones"],"prefix":"10.12688","volume":"5","author":[{"given":"Jeanett","family":"Klubien","sequence":"first","affiliation":[{"name":"Center for Perioperative Optimization, Department of Surgery Herlev Herlev Hospital"},{"name":"Faculty of Health and Medical Sciences Copenhagen University of Copenhagen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorte Winther","family":"Borgersen","sequence":"additional","affiliation":[{"name":"Department of Surgery Herlev Herlev Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0063-1086","authenticated-orcid":false,"given":"Jacob","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Center for Perioperative Optimization, Department of Surgery Herlev Herlev Hospital"},{"name":"Faculty of Health and Medical Sciences Copenhagen University of Copenhagen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christian","family":"Pommergaard","sequence":"additional","affiliation":[{"name":"Department of Surgery Hvidore Hvidovre Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1226-1232","DOI":"10.1007\/s00464-001-9173-8","article-title":"Complications due to gallstones lost during laparoscopic cholecystectomy.","volume":"16","author":"J Brockmann","year":"2002","journal-title":"Surg. Endosc."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"73-78","DOI":"10.1016\/j.amjsurg.2006.05.015","article-title":"Lost gallstones in laparoscopic cholecystectomy: all possible complications.","volume":"193","author":"J Zehetner","year":"2007","journal-title":"Am. J. Surg."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"305-309","DOI":"10.1007\/s004649900659","article-title":"Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies.","volume":"12","author":"M Sch\u00e4fer","year":"1998","journal-title":"Surg. Endosc."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/1752-1947-7-223","article-title":"The CARE guidelines: consensus-based clinical case reporting guideline development.","volume":"7","author":"J Gagnier","year":"2013","journal-title":"J. Med. Case Rep."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/BCR-2021-243198","article-title":"Bronchobiliary fistula: a rare postoperative complication of spilled gallstones from laparoscopic cholecystectomy.","volume":"27","author":"N Guruvaiah","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"17","DOI":"10.7759\/CUREUS.80556","article-title":"Spilled but Not Forgotten: A Retained Gallstone Leading to Colonic Fistula Formation.","volume":"14","author":"A Alzuabi","year":"2025","journal-title":"Cureus."},{"key":"ref7","first-page":"2803","article-title":"Abdominal fistula 7 years after laparoscopic cholecystectomy.","volume":"170","author":"K Houg\u00e5rd","year":"2008","journal-title":"Ugeskr. Laeger."},{"key":"ref8","first-page":"4520-4521","article-title":"Abscess in the right flank\u2014a late complication of laparoscopic cholecystectomy.","volume":"161","author":"J Hillings\u00f8","year":"1999","journal-title":"Ugeskr. Laeger."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"97-99","DOI":"10.1097\/SLE.0000000000000105","article-title":"Retained abdominal gallstones after laparoscopic cholecystectomy: a systematic review.","volume":"25","author":"B Demirbas","year":"2015","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T07:29:10Z","timestamp":1783668550000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":9,"URL":"https:\/\/doi.org\/10.12688\/f1000research.9490.3","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.9490.2","asserted-by":"subject"},{"id-type":"doi","id":"10.12688\/f1000research.9490.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.205380.r499873","asserted-by":"subject"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.10221.r16285, Gabriel Sandblom, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, 26 Sep 2016, version 1, 2 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v1#referee-response-16285","order":0,"name":"referee-response-16285","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jeanett Klubien<\/b>; \n<i>Posted: 20 Jan 2026<\/i>;  Did the report from the cholecystectomy include more detailed description of the spilled gallstones? Where the gallstones left in the trochar site (which could explain the subcutaneous fistlulas)? Where any attempts taken to extract the stones?  \n<i>Response: Thank you for this comment. The operative report did not have a more detailed description than already presented in the manuscript. All visible gallstones were removed intraoperatively, and the peritoneal cavity was irrigated with saline to retrieve any additional gallstones; no stones were left intentionally.<\/i> &nbsp;  Were any bacterial cultures taken? The aggressive local growth, with formation of abscesses as well as fistulas raised the suspicion of uncommon pathogens (e.g. Salmonella Virchow or Clostridium perfringens)  \n<i>Response: Thank you for this insightful comment. Unfortunately, information regarding bacterial cultures, including identification of specific pathogens, was not available. &nbsp;<\/i>  In the discussion \u201cIn this case, the gallstones were found on CT before complications developed.&nbsp; Perhaps, the abscesses and fistula could have been avoided if the stones had been removed when they were discovered.\u201d. Do the authors suggest a repeated laparoscopic procedure, even in asymptomatic patients, in order to remove spilled gallstones? This seems like a slightly hyperbolic recommendation from this single experience.&nbsp;A laparoscopic exploration aimed at discovering gallstones overseen at the first procedure may hardly be expected to reduce the risk of late complications.  \n<i>Response: We appreciate the comment and fully agree that a recommendation should not be based on a single case. We do not advocate for repeated laparoscopic exploration in asymptomatic patients to retrieve lost gallstones. We intended to reflect on this specific case, where calcifications presumed to be gallstones were identified on CT imaging. At that time, the patient\u2019s symptoms were mild, and the potential risks of surgical intervention were considered to outweigh the possible benefits.<\/i>","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3#referee-comment-15312","order":1,"name":"referee-comment-15312","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.10221.r16707, Tatsuhiro Masaoka, Department of Internal Medicine, Keio University School of Medicine, Tokyo, 160-8582, 10 Oct 2016, version 1, 2 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v1#referee-response-16707","order":2,"name":"referee-response-16707","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jeanett Klubien<\/b>; \n<i>Posted: 20 Jan 2026<\/i>;  Case report session is well written. Authors summarize the long progression in compact. I would like to know at one year after procedure how do authors indicate treatment options to patients and his family. Authors described a CT just showed swelling around calcification. However the patient&nbsp;was&nbsp;conscious of abdominal tenderness, and the cause of tenderness is assumed to be lost gallstone. I think operation must be considered as the best treatment at this point. Authors should discuss more about this point. During the period between 15 and 18 months following the LC, subcutaneous abscesses were&nbsp;formed. The patient was treated with ultrasound-guided incision and drainage. Did authors take&nbsp;bacterial culture? How about antibacterial treatment? Proper antibacterial treatment is important for preventing for progression of diseases. If done, authors should mention detail antibacterial treatment such as choices, doses, duration etc.  \n<i>Response: Thank you for this thoughtful comment. Unfortunately, detailed information regarding discussions of treatment options with the patient and family is not available. Likewise, no additional data regarding bacterial cultures or antibiotic therapy were available. We agree that microbiological evaluation and appropriate antibiotic treatment are important considerations in such cases, and we acknowledge this as a limitation of the present report.<\/i> &nbsp;  The discussion session&nbsp;is also well written. However authors did not mentioned fistula with communication to pleura. I would like to know why the patient developed fistula. What is the main factor of fistulization? The position of spilled gallstone? Inadequate treatment for abscess? Just after LC, did authors take CT? Of course operation for removing spilled gallstone might be best choice for preventing fistulization when the gallstone was found. Is there any other choice avoiding fistula with communication to pleura? Authors should discuss about this point  \n<i>Response: Thank you for this comment. The exact mechanism of the fistulation remains unclear, but it might have been driven by chronic inflammation originating from the retained gallstones. The anatomical location and repeated abscess formation likely contributed. While surgical removal of retained gallstones could have reduced the risk of fistula formation once <\/i>\n<i>identified, the decision must be balanced against operative risks, particularly in patients with mild or nonspecific symptoms.<\/i>","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3#referee-comment-15313","order":3,"name":"referee-comment-15313","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.205380.r499873, Emre Gonullu, Sakarya University Training and Research Hospital, Sakarya, 10 Jul 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/5-2322\/v3#referee-response-499873","order":4,"name":"referee-response-499873","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}