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Hem-o-lok clip migration to duodenal bulb post-cholecystectomy: A case report
Hong-Yan Liu1, Ai-Hong Yin1, Zhi Wei2
1Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan 250022, Shandong Province, China.
Insights
A Hem-o-lok clip migrated to the duodenal bulb after laparoscopic cholecystectomy, presenting as a submucosal tumor. The clip was successfully removed endoscopically, highlighting potential post-surgical complications.
Area of Science:
- Gastroenterology
- Surgical Complications
- Medical Device Migration
Background:
- Hem-o-lok clips are standard for controlling vessels and ducts during laparoscopic cholecystectomy (LC).
- Potential complications, including device migration, require clinical awareness.
Observation:
- A 72-year-old male developed a submucosal tumor (SMT)-like lesion in the duodenal bulb two years post-LC.
- Endoscopic evaluation revealed evolving characteristics of the SMT-like lesion over five months.
- A Hem-o-lok clip was identified and successfully removed from the duodenal wall via biopsy forceps.
Findings:
- Hem-o-lok clip migration to the duodenal bulb is a rare post-LC complication.
- Endoscopic findings demonstrated gradual changes in the migrated clip's appearance.
- Endoscopic clip removal is a feasible and safe treatment option.
Implications:
- Clinicians must consider Hem-o-lok clip migration as a differential diagnosis for duodenal submucosal lesions after LC.
- Symptomatic migrated clips warrant endoscopic evaluation and potential removal.
- This case underscores the importance of monitoring for delayed complications following laparoscopic procedures.
Background:
Hem-o-lok clips are typically used to control the cystic duct and vessels during laparoscopic cholecystectomy (LC) and common bile duct exploration for stones in the bile duct and gallbladder. Here, we report a unique example of Hem-o-lok clip movement towards the duodenal bulb after LC, appearing as a submucosal tumor (SMT). Additionally, we provide initial evidence of gradual and evolving endoscopic manifestations of Hem-o-lok clip migration to the duodenal bulb wall and review the available literature.
Case Summary:
A 72-year-old man underwent LC for gallstones, and Hem-o-lok clips were used to ligate both the cystic duct and cystic artery. Esophagogastroduodenoscopy (EGD) 2 years later revealed an SMT-like lesion in the duodenal bulb. Due to the symptomatology, the clinical examination did not reveal any major abnormalities, and the patient was followed up as an outpatient. A repeat EGD performed 5 months later revealed an SMT-like lesion in the duodenal bulb with raised edges and a central depression. A third EGD was conducted, during which a Hem-o-lok clip was discovered connected to the front side of the duodenum. The clip was extracted easily using biopsy forceps, and no complications occurred. Two months after the fourth EGD, the scar was surrounded by normal mucosa.
Conclusion:
Clinicians should be aware of potential post-LC complications. Hem-o-lok clips should be removed if symptomatic.
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