title: Surgical clips: a cause of late recurrent gallstones.
abstract: The formation of gallstones around surgical clips after cholecystectomy is a rare complication, with only seven reported cases in the English literature since its initial description in 1979. Three other cases report clip migration into the common bile duct and obstruction. We report a recent experience with "clip cholelithiasis." A 78-year-old female, 16 years following cholecystectomy, presented with a several-month history of colicky abdominal pain worsened by meals, and a 1 week history of jaundice, anorexia, nausea, and vomiting. An abdominal ultrasound demonstrated dilatation of the biliary tree without visible choledocholithiasis. Endoscopic retrograde cholangiopancreatography demonstrated a 1.5-cm radiolucent stone in the common bile duct containing a central surgical clip. She was successfully treated with endoscopic sphincterotomy and stone retrieval. The first report of clip cholelithiasis occurred in 1979. Six additional cases have been reported as well as three cases of clip migration without stone formation into the common bile duct. The incidence of clip cholelithiasis may increase in frequency with the increased use of metallic clips during laparoscopic cholecystectomy. The occurrence of cholelithiasis around inert metals is rare and may be prevented using absorbable clips; however, stone formation is also reported around absorbable materials.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Herline
authors.forename: J M
authors.initials: JM
authors.lastname: Fisk
authors.forename: J P
authors.initials: JP
authors.lastname: Debelak
authors.forename: H J
authors.initials: HJ
authors.lastname: Shull
authors.forename: W C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000042:Absorption; D000368:Aged; D000855:Anorexia / Q000209:etiology; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects / Q000295:instrumentation*; D003085:Colic / Q000209:etiology; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008670:Metals / Q000737:chemistry; D009325:Nausea / Q000209:etiology; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D013525:Surgical Instruments / Q000009:adverse effects; D014839:Vomiting / Q000209:etiology
chemical_list: D008670:Metals