Surgical clips found at the hepatic duct after laparoscopic cholecystectomy: a possible case of clip migration.
Surgical clip migration and subsequent stone formation in the common bile duct is a rare but well-established complication after laparoscopic cholecystectomy. There are some suggestions about the mechanisms of the migration process, but the details are still unclear. We report here a case in which common bile duct stones were formed around surgical clips, and other clips were found to have penetrated into the common hepatic duct, which we believe were in the process of migration after laparoscopic cholecystectomy. The patient required a laparotomy to retrieve the bile duct stones due to the distal stricture, and another laparotomy was necessary to remove the penetrating clips, which were deeply embedded in the bile duct wall. Although a variety of endoscopic and percutaneous interventional procedures are available in this era of modern medical technology, it is sometimes impractical to apply these procedures in such cases as ours, and exploratory laparotomy is sometimes required to correctly treat the patient. This case shows that the metallic surgical clips can penetrate into the intact bile duct wall through serial maceration, and we believe that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy.
Ahn
Seung-Ik
SI
Department of Surgery, Inha University College of Medicine, Incheon, Korea.
Lee
Keon-Young
KY
Kim
Sei Joong
SJ
Cho
Eung Ho
EH
Choi
Sun Keun
SK
Hur
Yoon Seok
YS
Cho
Young Up
YU
Hong
Kee-Chun
KC
Shin
Seok-Hwan
SH
Kim
Kyung Rae
KR
Woo
Ze-Hong
ZH
Jeong
Seok
S
D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery; D042882:Gallstones / Q000601:surgery; D006500:Hepatic Duct, Common; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D013525:Surgical Instruments