Biliary Granulomatous Peritoneal Reaction as Consequence of Cholecystectomy: Case Report and Literature Review

Bile or gallstone spillage during laparoscopic cholecystectomy occurs in 13 to 40% of cases of surgical dissection and extraction of a very inflamed gallbladder with friable or gangrenous walls. We present a case of a patient who developed a biliary granulomatous peritoneal reaction as consequence of cholecystectomy for acute-on-chronic cholecystitis. Our patient, after about 2 years from the surgery, in the follow-up imaging studies, showed multiple nodules disseminated in the peritoneal cavity suggestive for malignancy both on abdomen computer tomography scan and on positron emission tomography. Thus, laparoscopic nodulectomy lastly allowed the histologic diagnosis of biliary peritoneal granulomatous reaction. Even with benign assessment of nodules’ nature, these lesions showed a progressive trend of increasing over time in number and dimensions. We performed PubMed research of all cases reported in the literature to examine the cases features and to compare our findings with other clinical experiences reported by eleven international canters. Many patients were completely asymptomatic; as an occasional finding mimicking peritoneal seeding, further assessment to define the benign nature of these nodules were performed, so they underwent surgical treatment. The development of multiple abdominal nodules resulting from a foreign-body granulomatous reaction to bile/gallstones is a quite rare event after laparoscopic cholecystectomy, but we believe it should be seriously considered in patients who have undergone complicated surgical procedures on biliary tracts.