Spilled gallstones after laparoscopic cholecystectomy associated with pelvic pain

Case notes

A 41 year old gravida 3 para 3 woman presented with heavy cyclic uterine bleeding and a 3 year history of worsening dysmenorrhea progressing to crampy pelvic pain unrelated to menses. A pelvic examination revealed a slightly enlarged, mobile uterus without adnexal masses but diffuse tenderness and no rectovaginal nodularity. Transvaginal ultrasound demonstrated a 3 cm fundal myoma with normal adnexa and no foreign bodies. Trials of nonsteroidal antiinflammatory drugs, oral contraceptive pills, and a levonorgestrel intrauterine device improved her bleeding but failed to relieve her pain. Notably, she had undergone laparoscopic cholecystectomy 9 years prior to presentation.

Laparoscopic-assisted vaginal hysterectomy revealed a small myomatous uterus and 13 gallstones scattered throughout the pelvis, adherent to the bladder ( Figure 1 ), pelvic sidewalls ( Figure 2 ), and right ovary ( Figure 3 ). The stones were carefully dissected and removed with a laparoscopic gallstone grasper. Laparoscopic-assisted vaginal hysterectomy was completed and the patient denied any further pelvic pain or cramping at 6 weeks and 3 months postoperatively.