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. 2015:2015:504295.
doi: 10.1155/2015/504295. Epub 2015 Mar 22.

Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

Natalie E Cookson  1 , Reza Mirnezami  2 , Paul Ziprin  2
Affiliations

Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

Natalie E Cookson et al. Case Rep Gastrointest Med. 2015.

Abstract

Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation "clip cholelithiasis". Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT) imaging revealed hyperdense material in the common bile duct (CBD) compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP) revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient's jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.

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Figures

Figure 1
Figure 1
CT abdomen demonstrating (a) hyperdense material corresponding to surgical clip(s) in gallbladder fossa and (b) hyperdense material in the distal CBD.
Figure 2
Figure 2
Images obtained at ERCP demonstrating intra- and extrahepatic ductal dilatation secondary to an occluding stone in the distal CBD, passing through the pancreatic head, formed around two migrated surgical clips.
See this image and copyright information in PMC

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