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Case Reports
. 2019 Nov;98(48):e18153.
doi: 10.1097/MD.0000000000018153.

Migration of hem-o-lock clips and stitches into the duodenum after laparoscopic hepatectomy and cholecystectomy: A case report

Yan Xia  1 , Xiao-Fei Gao  2 , Cheng-Yu Shi  3 , Yuan-Hui Jiang  4 , Xin Yi  4
Affiliations
Case Reports

Migration of hem-o-lock clips and stitches into the duodenum after laparoscopic hepatectomy and cholecystectomy: A case report

Yan Xia et al. Medicine (Baltimore). 2019 Nov.

Abstract

Rationale: Migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy is incredibly rare with a poorly understood mechanism.

Patient concerns: A 56-year-old woman who underwent laparoscopic left hepatectomy and cholecystectomy in August 2016 was admitted to our hospital with nausea and vomiting in December 2017.

Diagnoses: Abdominal computed tomography (CT) scan showed high density shades in duodenal ampulla. Esophagogastroduodenoscopy showed deformation of the duodenal ampulla into two lumens; hem-o-lock clips and stitches were detected in the upper lumen. Contrast enhanced CT scan revealed gastric cancer with liver metastasis (GCLM).

Interventions: The hem-o-lock clips and stitches were present in the wall of the duodenum; therefore, no attempt was made to remove them. High quality liquid diet, partial parenteral nutrition, and chemotherapy were administered to the patient.

Outcomes: In September 2018, the patient died of hepatic failure caused by GCLM.

Lessons: This rare complication of the migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy can cause epigastric pain and duodenal obstruction. The complication could be potentially avoided using absorbable endoclips and stitches or by performing of ultrasonic dissection by a skilled operator.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Contrast enhanced computed tomography (CT) scan showed hepatic metastasis (arrow).
Figure 2
Figure 2
Computed tomography (CT) scan showed high density shades on the duodenal wall (arrow).
Figure 3
Figure 3
Endoscopic image of the duodenum showed hem-o-locks (A) and stitches (B) in the first part of duodenum wall.
See this image and copyright information in PMC

References

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