Surgical Clip Migration and Choledocholithiasis: A Late, Abrupt Complication of Laparoscopic Cholecystectomy

Excerpt

Surgical clip migration leading to choledocholithiasis and biliary obstruction is a rare but established complication of biliary surgery. The incidence has increased with the rise in laparoscopic cholecystectomy (LC), although the exact pathogenesis remains unknown. It is generally agreed that improper clip placement and inflammation around the biliary tree are risk factors for clip migration. Although symptoms tend to develop months to years after surgery, the time course of migration and lithogenesis is unclear. In this report, we describe a case of a surgical clip migrating into the bile duct as the nidus for a gallstone 6 years after LC. It was successfully treated with endoscopic retrograde cholangiography (ERC). Between LC and the presentation described herein, the patient underwent periodic ERC as treatment for a biliary stricture, including an exam 8 weeks before. None of these showed intraductal clips or stones. This case illustrates the potentially abrupt and late development of clip-related gallstones and highlights the need to stay vigilant for such complications throughout long-term follow-up. …