LOST STONE IN THE ABDOMINAL CAVITY

        In the era of laparoscopic cholecystectomy, inadvertent opening of the gall bladder is not infrequent in 20% to 40% of laparoscopic cholecystectomies. Risk factors for the intra-operative perforation of gall bladder include presence of severe cholecystitis, gangrenous or perforated gall bladder and number of stones more than 15. These lost stones can have significant consequences like chronic abscess formation, development of fistula, wound infection and intestinal obstruction. Most of the stones settle behind the liver. But full effort should be taken to remove all the spilled stones in the abdominal cavity. However, based on available studies, lost stones do not necessitate conversion to open operation. The treatment should include extensive irrigation, a course of antibiotics, and documentation of the perforation of the gall bladder during surgery in the operation notes.