Percutaneous Removal of Spilled Gallstones after Laparoscopic Cholecystectomy

Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs frequently, but clinical sequelae caused by dropped gallstones are uncommon. We present a case of subhepatic and right-back abscess formation due to spilled gallstones occurring two years after LC, which were successfully removed using a percutaneous method as a minimally invasive technique. The patient firstly visited a primary care physician with right-back mass that was increasing in size and becoming symptomatic, then underwent incision and drainage. He was referred to our hospital and the subhepatic and right-back inflammatory mass containing spilled gallstones was revealed by computed tomography. Under fluoroscopic control, a percutaneous drainage catheter was placed within the abscess and pus was aspirated. The spilled gallstones were successfully retrieved with basket forceps, thereafter. The patient was discharged without significant complications on the 9th day after the percutaneous stone removal.

The Effect of Combination Intraluminal Brachytherapy and External Beam Radiotherapy for the Treatment of Unresectable Hilar Cholangiocarcinoma

PURPOSE: The purpose of this study was to evaluate the effect of combination intraluminal brachytherapy (ILBT) and external beam radiotherapy (EBRT) on patient survival and stent patency after metallic biliary stent placement in patients with unresectable hilar cholangiocarcinoma. METHODS: We retrospectively analyzed the data of 29 patients with unresectable hilar cholangiocarcinoma who presented between January 2002 and December 2006. Fifteen patients were treated with metallic stents alone (RT (-) group), and 14 patients were treated with ILBT and EBRT after metallic stent placement (RT (+) group). ILBT was performed using a 192Ir source at a dose of 15 Gy in 3 fractions. The EBRT dose was 45 Gy in 25 fractions. RESULTS: The 1- and 3-year patient survival rates in the RT (+) group were 51.9% and 8.7%, respectively, and those in the RT (-) group were 46.7% and 38.9%, respectively. However, there was no statistically significant difference in the survival rates between the two groups (p=0.38). The 1- and 2-year stent patency rates for the RT (+) group were numerically higher than those in the RT (-) group (74.0%, 74.0%, respectively vs. 59.9%, 39.9%, respectively), but not to a statistically significant degree (p=0.11). The median stent patency was 10 months in the RT (+) group and 8 months in the RT (-) group. All of the stents obstructed at 31 months in the RT (+) group and at 26 months in the RT (-) group. Four patients showed minor complications, including gastrointestinal discomfort and dermatitis after radiation therapy, but all of them responded well to conservative treatment. CONCLUSION: Although combined ILBT and EBRT for unresectable hilar cholangiocarcinoma was safely carried out after biliary stent insertion with minor complications, it did not have a significant role in improving the survival and stent patency rates.