Choledochal 'clipoliths' after cholecystectomy

Residual or recurrent stones in the common bile duct can pose a difficult diagnostic problem in the symptomatic postcholecystectomy patient. Although incrustation of unabsorbed suture material is the most important cause of stone recurrence in the common bile duct after surgery, hemostatic clips may also (though rarely) provide a nucleus for stone formation. We present two cases in which this occurred. Careful attention to the position and orientation of surgical clips on serial postoperative film studies can be most helpful in diagnosing this rare condition.