Ppr

Figure 4.29. "Dropped stones" after cholecystectomy. (A) CT scan of the upper abdomen demonstrates calcific densities due to calculi in the perihepatic space with associated small amount of fluid. (B) Another patient with similar findings. (C) CT scan of the upper abdomen in another patient with multiple calculi and fluid in the right subhepatic space. (D) Sonogram in a fourth patient demonstrating fluid and a calculus in the pelvis.

Figure 4.29. "Dropped stones" after cholecystectomy. (A) CT scan of the upper abdomen demonstrates calcific densities due to calculi in the perihepatic space with associated small amount of fluid. (B) Another patient with similar findings. (C) CT scan of the upper abdomen in another patient with multiple calculi and fluid in the right subhepatic space. (D) Sonogram in a fourth patient demonstrating fluid and a calculus in the pelvis.

Figure 4.30. "Dropped stones after cholecystectomy. "Dropped stones" migrating into the pleural space with empyema.
Figure 4.31. "Dropped clip" after cholecystectomy. Plain film of the abdomen shows a closed surgical clip in the pelvis that had "dropped" from the right upper quadrant.

Abscesses may be drained percutaneously, and associated percutaneous dropped stone removal has also been reported [53]. Stones less than 1 cm in diameter usually can be removed by a 30F sheath, whereas stones greater than 1 cm must be fragmented before removal.

"Dropped" clips after LC are also fairly common, with 19 patients in a series of 52 demonstrating one or more ectopic clips on intraoperative or postoperative radiographs [54] (Fig. 4.31). Most of these clips were closed, although some were open. The most common location was the right lower quadrant. The significance, if any, of "dropped" clips is yet to be determined.

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