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Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy
Yijie Yin1, Su Kah Goh2, Reizal Mohd Rosli1
1Hepatopancreaticobiliary Surgery Unit, Royal Adelaide Hospital, Adelaide, AUS.
Cureus
|November 29, 2023
Summary
Surgical clips can migrate into the common bile duct (CBD) years after laparoscopic cholecystectomy, causing biliary obstruction. This rare complication requires prompt diagnosis and endoscopic management for excellent outcomes.
Area of Science:
- Gastroenterology
- Surgical Complications
- Biliary Tract Disease
Background:
- Laparoscopic cholecystectomy frequently utilizes titanium surgical clips for duct and vessel ligation.
- Clip dislodgement is a known complication, but migration into visceral structures causing obstruction is rare.
Observation:
- A case of acute surgical clip migration into the common bile duct (CBD) occurred 32 years post-laparoscopic cholecystectomy.
- Initial CT showed clips correctly placed; three weeks later, repeat CT revealed clips within the CBD, causing acute cholangitis.
Findings:
- The migration was attributed to gradual erosion of the bile duct, potentially due to pressure from organ movement or subtle clip shifts.
- This erosion led to intra-ductal migration and obstruction of the CBD.
Implications:
- Highlights the importance of considering delayed surgical clip migration in patients with unexplained biliary obstruction.
- Successful management involved standard biliary obstruction treatment and endoscopic retrograde cholangiopancreatography (ERCP).
