Surgery for Surgeons

The day before yesterday I did a cholecystectomy of a patient with a stone passage and elevated transaminases, alcaline phosphatase and bilirubine. At the laparoscopy we saw a liver in an advanced stage of cirrhosis. This explained the preoperative estimated splenomegaly and a consecutive thrombopeny. We discovered that the reason for the liver cirrhosis was a hepatitis C. Neither this condition, nor the cirrhosis or any other finding were known previously. The 46 yo patient lives in Marocco visiting now his brother in Germany and told us that he rarely goes to a physician, who lately (about a year ago) found a diabetes and nothing else (!).

Acute abdominal pain was a reason for a performed plain abdominal x-ray, where a gallstone could be seen in a typical projection over the gallbladder:

The cholecystectomy was somehow difficult due to the overall condition of the patient with a CHILD C cirrhosis. The corresponding stone found in the gallbladder is shown below:

After more than 110 laparoscopic cholecystectomies performed by me, this is the first time I see a x-ray opaque gallbladder stone. In the most cases no abdominal plain x-ray was performed though. Nevertheless a quick review of the literature showed that calcium, as a dominant component of gallbladder stones, is a rare condition.