Retained gallstone

Retained gallstones, also called dropped or slipped gallstones, are common during a laparoscopic cholecystectomy, with a reported incidence of 0.1–20%, and occur when gallstones are inadvertently spilled into the peritoneal cavity.

Many cases of dropped gallstones will be asymptomatic. However, patients may become symptomatic if a complication develops and may present with infective symptoms, pain or fistula (e.g. colovesical fistula) formation.

Perforation of the gallbladder during surgery may release a gallstone into the peritoneal cavity. Abscess and fistula formation are possible as a result of the stone.

Dropped gallstones may have the following appearances on CT 2:

  • initially calcified stones may appear as one or multiple hyperdense foci in Morrison's pouch, the gallbladder fossa and the pelvis
  • cholesterol or pigmented stones may be more difficult to appreciate
  • local abscess or fistula formation may also be evident in some cases

MRI appearance depends on the composition of the stone 3.

Pigmented stones appear as:

  • T1: hypertense

​Other types of stones appear:

  • T1: hypointense
  • T2: hypointense

Stones do not show enhancement with contrast.

The dropped stone will generally need to be removed if it is causing complications (e.g. abscess formation). 

Consider the following 3:

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Article information

rID: 12717
Section: Gamuts
Synonyms or Alternate Spellings:
  • Retained gallstones
  • Dropped gallstone
  • Dropped gallstones
  • Spilled gallstones

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