Displacement of Hem-o-lok clips into the common bile duct after LCBDE: a case report

Laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) is the standard treatment for hepatobiliary calculi. While postoperative complications have decreased with technical maturation, migration of polymer ligation clips (e.g., Hem-o-lok) remains an underrecognized yet serious complication that can serve as a nidus for recurrent stone formation and cholangitis, necessitating heightened clinical awareness.

We present a case of a 76-year-old female who presented with fever and chills three years after initial LCBDE. Imaging studies (CT/MRI) revealed choledocholithiasis with a central linear hyperdensity suggestive of migrated clips. The patient underwent laparoscopic bile duct re-exploration.

Intraoperative findings confirmed multiple Hem-o-lok clips within the common bile duct, one embedded at the core of a large stone. All clips and stones were successfully removed, followed by T-tube drainage. The patient recovered rapidly with targeted antibiotic therapy and was discharged on postoperative day three.

Although rare, clip migration should be considered in patients with late-onset biliary symptoms after LCBDE. This case underscores the importance of meticulous clip application and suggests the need for long-term follow-up and possibly alternative closure techniques to prevent this consequential complication.