Acute Obstructive Jaundice Secondary to Surgical Clip Migration Into the Common Bile Duct 12 Years Following...

Surgical clip migration to the common bile duct is a rare late complication, typically originating from clips placed at the cystic duct and most commonly reported after laparoscopic cholecystectomy. We present an exceptionally rare case of obstructive jaundice caused by clip migration from the liver dissection plane, rather than from the cystic duct, occurring 12 years after laparoscopic liver resection (LLR) and cholecystectomy and associated with chronic biliary inflammation. A 73-year-old man underwent LLR of segments 4a + 5 and cholecystectomy for hepatocellular carcinoma and was discharged on postoperative day 12 without any complications. Three months later, computed tomography revealed a fluid collection along the liver dissection plane and dilation of the bile duct of segment 3 of the liver (B3), both of which were followed up without intervention due to the absence of symptoms and significant abnormalities in laboratory data. Eight years later, he required percutaneous transhepatic biliary drainage (PTBD) from the B3 due to bile duct stenosis and recurrent cholangitis. He was followed up as an outpatient with regular PTBD tube exchanges. Twelve years after the LLR, he developed acute obstructive cholangitis caused by a high-density lesion in the distal bile duct. Endoscopic removal identified the lesion as a migrated surgical clip. Because the clips at the cystic duct stump remained in place, the migrated clip was identified as originating from the liver dissection plane. Since surgical clip migration to the common bile duct following cholecystectomy has been reported to result from inflammation around the cystic duct stump, the clip migration observed in this patient may also be associated with chronic inflammation along the liver dissection plane or the PTBD tract. Chronic inflammation along the liver dissection plane may have led to the clip migration. Surgeons should be aware of the potential for clip migration from the liver dissection plane into the common bile duct as a rare long-term complication following LLR, especially in patients with chronic inflammation around the bile duct.