title: Bile leakage presenting as acute abdomen due to a stone created around a migrated surgical clip.
abstract: BACKGROUND
  Surgical clips may migrate into the common bile duct after surgery for cholecystolithiasis leading to usually early or middle-term complications.
  
  
  METHODS
  A 31-year-old woman, 6 years after laparoscopic cholecystectomy, developed acute abdomen and choloperitoneum after rupture of a secondary bile duct and bile leakage. This complication was due to a solitary common bile duct stone. The stone was formed around a surgical clip that had migrated from the cystic duct remnant to the common bile duct. The patient underwent investigative laparotomy and, subsequently, an ERCP with stone extraction and clearance of the common bile duct. She was perfectly well at the follow-up after 14 months.
  
  
  CONCLUSIONS
  Rupture of a bile duct and biliary peritonitis may be a delayed complication of laparoscopic cholecystectomy due to surgical clip migration and formation of a stone. Definitive treatment of the condition may be achieved through ERCP. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdomen.
authors.affiliation: Gastroenterology Department, University Hospital, Heraklion, Greece. mouzas@med.uoc.gr
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Mouzas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrakis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Vardas
authors.forename: Nektarios
authors.initials: N
authors.lastname: Kogerakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Skordilis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Prassopoulos
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation*; D003135:Common Bile Duct / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging; D042882:Gallstones / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D013525:Surgical Instruments / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors