E0055 - Caseating Granulomas Caused by Dropped Gallstones Post Cholecystectomy

Harleen Kaur, MD, Feenalie Patel, MD, Niharika Samala, MD
Indiana University School of Medicine, Indianapolis, IN

Introduction: We present an interesting case of a patient with a history of cholelithiasis with cholecystectomy found to have caseating granulomatous lesions in the liver and peritoneal cavity, ultimately found to have "drop gallstone." With laparoscopic cholecystectomy becoming the standard of treatment, this case illustrates the importance of having high suspicion for this diagnosis and its complications, as it can lead to unnecessary diagnostic testing to rule out autoimmune or malignant mimics.

Case Description/Methods: A 74-year-old male with remote history of metabolic co-morbidities, cholelithiasis status post cholecystectomy, and spinal cord injury complicated by neurogenic bladder who presented with generalized weakness, found to have leukocytosis and electrolyte abnormalities on admission at outside hospital. Computed tomography of abdomen and pelvis scan showed several low-density lesions in the liver and scattered indistinct nodules throughout the peritoneal cavity and abdominal wall musculature. Biopsy results showed caseating granulomatous inflammation and fibrinoid necrosis concerning for an autoimmune or malignant process. However, autoimmune and oncologic work-up were overall unremarkable. Upon transfer to our hospital, secondary pathology review of the biopsies additionally noted bile acid casts and refractile material consistent with gallstones, diagnosing him with “dropped gallstone.”

Discussion: Stones or biliary leakage into the abdominal cavity at the time of a laparoscopic cholecystectomy can lead to complications including chronic inflammation that can mimic malignancy or autoimmune disease. Thorough irrigation and evacuation of the gallbladder fossa and abdominal cavity during the procedure can help minimize this complication. High clinical suspicion for "drop gallstone" can minimize unnecessary diagnostic testing for the patient.


Disclosures:


Harleen Kaur, MD, Feenalie Patel, MD, Niharika Samala, MD. E0055 - Caseating Granulomas Caused by Dropped Gallstones Post Cholecystectomy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.