30 years later-a case report of late surgical clip migration after laparoscopic cholecystectomy

Surgical clip migration is a rare complication that can happen many years following a successful cholecystectomy. It has a similar clinical presentation as choledocholithiasis. The diagnosis is usually made using imaging modalities such as ultrasounds, computed tomography (CT) scans, or magnetic resonance cholangiopancreatography (MRCP). If left untreated, complications such as acute cholangitis, acute pancreatitis, clip embolism, duodenal ulcer, and obstructive jaundice can develop. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for extracting the migrated clip with a high success rate. Surgical exploration is rarely required and reserved for complicated situations such as the presence of biliary stricture, fistula or concurrent large stones.

We are presenting a case of a 51-year-old female who experienced a surgical clip migration 30 years after her laparoscopic cholecystectomy. The patient presented with abdominal pain and found to have deranged liver function test. Abdominal CT showed a dilated common bile duct (CBD) of 1.1 cm with a lodged metallic density within the CBD consistent with a surgical clip. ERCP was subsequently performed, which confirmed the presence of 1 cm free floating clip within the CBD.

Laparoscopic cholecystectomy carries risk of late complications like surgical clip migration, and it should be considered as a differentia in patients presenting with picture of choledocholithiasis.