Choledochoduodenal fistula caused by migration of endoclip after laparoscopic cholecystectomy.
The wide use of surgical endoclips in laparoscopic surgery has led to a variety of complications. Post-cholecystectomy endoclips migrating into the common bile duct after laparoscopic cholecystectomy is rare. A migrated endoclip can cause obstruction, serve as a nidus for stone formation, and cause cholangitis. While the exact pathogenesis is still unknown, it is probably related to improper clip application, subclinical bile leak, inflammation, and subsequent necrosis, allowing the clips to erode directly into the common bile duct. We present a case of endoclip migrating into the common bile duct and duodenum, resulting in choledochoduodenal fistula after laparoscopic cholecystectomy and a successful reconstruction of the biliary tract by a hepaticojejunostomy with a Roux-en-Y procedure. This case shows that surgical endoclips can penetrate into the intact bile duct wall through serial maceration, and it is believed that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy.
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Tao
T
Hong
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Xie-Qun
XQ
Xu
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Xiao-Dong
XD
He
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Qiang
Q
Qu
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Bing-Lu
BL
Li
Tao Hong, Xie-Qun Xu, Xiao-Dong He, Qiang Qu, Bing-Lu Li, Chao-Ji Zheng, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Chao-Ji
CJ
Zheng
D000713:Anastomosis, Roux-en-Y; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation*; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007582:Jejunostomy; D008875:Middle Aged; D012086:Reoperation; D013525:Surgical Instruments / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
Biliary obstruction; Choledochoduodenal fistula; Laparoscopic cholecystectomy