Case report: Dropped gallstones diagnosis is hindered by incomplete surgical notes and a low index of suspicion

INTRODUCTION AND IMPORTANCE: Diagnosis and treatment of dropped gallstones (DG) complications can be delayed due to a low index of suspicion by treating physicians. This delay may derive from incomplete surgical notes that disregard and underreport DG. This report highlights the management of two cases of DG-related abscesses with incomplete surgical notes and how a high index of suspicion can bear positively on treatment results. CASE PRESENTATION: Two patients, a 62 and a 71-year-old female, presented intraabdominal abscess' resulting from DG from a prior laparoscopic cholecystectomy (LC). In neither patient did the surgical notes report the occurrence of DG. Both patients were treated with percutaneous drainage; however, their recovery was markedly different. In one case, an association with DG was not suggested until after several months of repeated abscess occurrence. In the other case, it was suggested early in the treatment, allowing for a shorter and improved recovery. CLINICAL DISCUSSION: DG diagnosis is hindered by incomplete surgical notes and a low index of suspicion. Improvements in management can occur only if surgeons dependably report DG episodes. Percutaneous drainage of DG abscess under local anesthesia is less invasive than a laparoscopic or surgical approach and can be performed on an outpatient basis with or without using various stone fragmentation tools. CONCLUSION: A high index of suspicion of DG can positively impact the treatment of these cases, therefore, reporting DG events during surgery is necessary. Percutaneous drainage with saline irrigation is safe and effective in selected patients with DG abscesses.