Migrated Surgical Clip as a Nidus for Choledocholithiasis 8 Years Postcholecystectomy

Area of Science:

• Gastroenterology
• Surgical Complications
• Biliary Interventions

Background:

• Surgical clip migration is an infrequent but significant cause of delayed complications following cholecystectomy.
• Late-onset biliary obstruction presents a diagnostic challenge, especially when related to foreign body migration.

Purpose of the Study:

• To report a case of late biliary obstruction due to a migrated surgical clip after laparoscopic cholecystectomy.
• To illustrate the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy and electrohydraulic lithotripsy in managing such complications.

Main Methods:

• A patient with a history of cholecystectomy presented with symptoms of biliary obstruction.
• Diagnostic imaging revealed a common bile duct stone; ERCP with cholangioscopy identified a migrated surgical clip as the stone's nidus.
• Electrohydraulic lithotripsy was employed for stone fragmentation, followed by balloon extraction and stent placement.

Main Results:

• The migrated surgical clip was successfully identified as the nidus for the common bile duct stone.
• Electrohydraulic lithotripsy effectively fragmented the stone.
• The patient experienced an uneventful recovery after the endoscopic intervention and stent placement.

Conclusions:

• Clip migration should be considered in the differential diagnosis of late-onset biliary obstruction post-cholecystectomy.
• Cholangioscopy-guided electrohydraulic lithotripsy is a viable and effective treatment for complex common bile duct stones associated with migrated clips.