Pulmonary embolization of a vascular ligature clip as a complication of para-aortic lymph node sampling

A case is reported of a 57-year-old woman who underwent cytoreductive surgery for stage III, grade 2 endometrioid cystadenocarcinoma of the ovary. During para-aortic lymph node sampling, hemostasis was achieved with medium and small metallic ligature clips. The immediate postoperative period was uneventful and the chest radiograph was unchanged from preoperative film. On the sixth postoperative day a chest radiograph showed a radio-opaque object consistent with a metallic ligature clip in the peripheral left middle lung field. The remaining postoperative course was uncomplicated and the patient is well 14 months postoperatively; the ligature clip is unchanged in position. This is an interesting and previously unreported complication of para-aortic lymph node sampling. The means by which the clip entered the vascular system is unknown. Nonsurgical removal of the clip was not feasible due to its peripheral location. No studies exist as to the long-term outcome of foreign bodies embolized to the peripheral lung.