GRANULOMATOUS PERITONITIS AFTER LAPAROSCOPIC CHOLECYSTECTOMY MIMICKING PELVIC ENDOMETRIOSIS

In Brief Background: Spillage of bile or gallstones, a relatively common occurrence during laparoscopic cholecystectomy, is believed to be inconsequential, but we describe a case of postlaparoscopic granulomatous peritonitis mimicking endometriosis. Case: A 20-year-old gravida 0 presented with chronic lower abdominal pain and dysmenorrhea. Laparoscopy showed red-brown pigmented pelvic adhesions, which on biopsy showed foreign-body–type granulomatous reaction, both suggesting endometriosis, but a history of laparoscopic cholecystectomy and a positive Fouchet's stain for bile gave the true etiology of the granulomatous reaction. Conclusion: With increasingly widespread use of laparoscopic cholecystectomy, and relatively common spillage of bile or gallstones at surgery, granulomatous peritonitis mimicking endometriosis might become more frequent. Peritoneal reaction to bile or gallstones can mimic endometriosis at clinical presentation and laparoscopy.