Retained Gallstones After Laparoscopic Cholecystectomy as a Cause of Chronic Pelvic Pain

In Brief Background: The spillage of gallstones during laparoscopic cholecystectomy is a common occurrence and is often considered innocuous. Retained gallstones can easily coalesce within the pelvis. As a result, they have been shown to cause gynecologic symptoms (pelvic pain, dyspareunia, dysmenorrhea, infertility) and can mimic gynecologic pathology (endometriosis, adenomyosis, pelvic adhesive disease). Case: A 37-year-old G4P3012 underwent a total abdominal hysterectomy and bilateral salpingooophorectomy secondary to dysmenorrhea, chronic pelvic pain, and failed medical management of her symptoms (oral contraceptive pills and leuprolide). Preoperative ultrasound and computed tomography scan of the abdomen and pelvis failed to identify a likely source for her pain. Intraoperative findings were remarkable for multiple embedded and invasive gallstones, several greater than 1.0 cm, adherent to and within the uterus, ovaries, fallopian tubes, and pelvic sidewalls. The patient had undergone laparoscopic cholecystectomy 10 years previously. Conclusions: The spillage of gallstones is not inconsequential and every effort should be made to retrieve them. Those that are retained have a demonstrated ability to produce pelvic adhesive disease, pain, and dysmenorrhea, and may impair fertility. Retained gallstones after laparoscopic cholecystectomy should be considered a valid component of any differential diagnosis in patients presenting with gynecologic complaints. As more female patients of reproductive age undergo laparoscopic cholecystectomy, symptoms from retained gallstones will increase. They have been shown to cause gynecologic symptoms (pelvic pain, dyspareunia, dysmenorrhea, infertility) and can mimic gynecologic pathology (endometriosis, adenomyosis, pelvic adhesive disease). Symptomatic pelvic cholelithiasis highlights a syndrome which the general surgeon and gynecologic surgeon should become more familiar and consider in their clinical and operative plan of care.