title: Post-laparoscopic cholecystectomy Mirizzi syndrome induced by polymeric surgical clips: a case report and review of the literature.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is the gold standard treatment of gallbladder disease. Post-cholecystectomy syndrome is a severe postoperative complication which can be caused by multiple mechanisms and can present with multiple disorders. The wide use of laparoscopy induces the need to understand more clearly the presentation and pathophysiology of this syndrome. Post-cholecystectomy Mirizzi syndrome is one form of this syndrome and, according to literature, this is the first report that clearly describes it.
  
  
  METHODS
  We describe the case of a 62-year-old Greek woman who underwent laparoscopic cholecystectomy because of gallstone disease. A few days after surgery, post-cholecystectomy syndrome gradually developed with mild bilirubin increase in association with epigastric pain, nausea, and vomiting. After performing ultrasound, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography, we conducted a second laparoscopic surgery to manage the obstruction, which was converted to open surgery because of the remaining inflammation from the post-endoscopic retrograde cholangiopancreatography acute pancreatitis. Four polymeric laparoscopic clips were removed because they were identified as the cause of her post-cholecystectomy syndrome. She had a quick recovery without further complications.
  
  
  CONCLUSIONS
  Postoperative Mirizzi syndrome induced by the migration of polymer laparoscopic clips is a rare (only one case referring to polymeric clips has been published in the literature) but a well-identified complication of laparoscopic cholecystectomy which can confuse the diagnostic and therapeutic field requiring simultaneous immediate management.
authors.affiliation: Second Department of Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece. eleninagorni@windowslive.com.
authors.forename: Eleni-Aikaterini
authors.initials: EA
authors.lastname: Nagorni
authors.affiliation: Gastrointestinal Endoscopy Unit, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kouklakis
authors.affiliation: Second Department of Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Tsaroucha
authors.affiliation: Department of Radiology and Medical Imaging, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Soultana
authors.initials: S
authors.lastname: Foutzitzi
authors.affiliation: Department of Radiology and Medical Imaging, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Courcoutsakis
authors.affiliation: Second Department of Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Romanidis
authors.affiliation: Department of Radiology, Didimotichon General Hospital, Didimotichon, 68300, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vafiadis
authors.affiliation: Second Department of Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Pitiakoudis
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017562:Postcholecystectomy Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D013525:Surgical Instruments / Q000009:adverse effects; D014463:Ultrasonography
keywords: Clip migration; Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy; Mirizzi syndrome; Polymer laparoscopic clip; Post-cholecystectomy syndrome