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Case Reports
. 2020:74:205-208.
doi: 10.1016/j.ijscr.2020.08.027. Epub 2020 Aug 29.

Late biliary endoclip migration after laparoscopic cholecystectomy: Case report and literature review

Hytham K S Hamid  1 , Anna Fullard  2 , Jamaleldin Sabahi  2 , Sean M Johnston  2
Affiliations
Case Reports

Late biliary endoclip migration after laparoscopic cholecystectomy: Case report and literature review

Hytham K S Hamid et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Although formerly considered a rarity, biliary endoclip-related complications are being diagnosed with increasing frequencies. Among these, migration of endoclip into the common bile duct (CBD) is a rare encounter that usually presents in the first two years after surgery.

Presentation of case: This case demonstrates a late biliary endoclip migration after laparoscopic cholecystectomy.

Discussion: An 82-year-old male patient, with a history of laparoscopic cholecystectomy 22 years ago, presented with two-day history of severe upper abdominal pain. Routine hemogram and serum chemistry were remarkable for slightly raised alanine aminotransferase and C-reactive protein. A computed tomographic (CT) scan demonstrated a new metallic density within the CBD when compared to a previous CT scan 14 months earlier. An endoscopic retrograde cholangiography confirmed a metal endoclip within the mid-CBD contained within a choledochal stone. Balloon extraction of the endoclip and stone was successfully performed. The patient was discharged 2 days later, and remained symptom free for 1 year.

Conclusion: To our knowledge, a latency of 22 years between cholecystectomy and clip migration has never been reported before. In cases of post-cholecystectomy abdominal pain the awareness of the surgeon should always be drawn to a clinical suspicion of endoclip migration into the CBD that can be easily remedied. Endoscopic biliary sphincterotomy with endoclip/stone removal is the therapeutic procedure of choice which usually circumvents the need for surgical extraction.

Keywords: Cholecystectomy; Endoclip; Laparoscopic; Migration.

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Figures

Fig. 1
Fig. 1
Coronal enhanced CT scan exhibiting a linear metallic density in the CBD consistent with a surgical endoclip.
Fig. 2
Fig. 2
a, b Axial enhanced CT scan demonstrating three endoclips in the hepatic hilum (a) compared with two endoclips in the same location 14 months later (b).
Fig. 3
Fig. 3
ERCP showing the clip/stone adjacent to the head of the endoscope in the duodenum, following successful extraction.
Fig. 4
Fig. 4
ERCP showing the stone in the duodenum after extraction.
See this image and copyright information in PMC

References

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