Ischemic mass effect from biliary surgical clips.
Migrating surgical clips in the hepatic hilum are known causes of biliary stricture or obstruction, most often due to direct intraluminal obstruction or secondary stone formation. Two cases are reported on patients with previous cholecystectomies presenting with delayed symptoms of biliary tract stricture. Both patients were successfully treated with a resection of the strictured area and a Roux-en-Y hepatico-jejunostomy. Resected specimens grossly demonstrated surgical clips adjacent to the stricture, but not directly within the lumen, suggestive of an ischemic mass effect, which was supported by histology. In addition to the direct intraluminal obstruction and lithogenic effects of migratory surgical clips, "clipomas" due to an ischemic mass effect can also lead to biliary tract strictures.
Mateo
Rod
R
Division of Transplantation and Hepatobiliary/Pancreatic Surgery, Department of Surgery, Keck-USC School of Medicine, Los Angeles, California, USA. rod.mateo.usc@tenethealth.com
Tsai
Steven
S
Stapfer
Maria V
MV
Sher
Linda S
LS
Selby
Rick
R
Genyk
Yuri S
YS
D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D003137:Common Bile Duct Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D011183:Postoperative Complications; D013525:Surgical Instruments / Q000009:adverse effects*