A CASE OF A COMMON BILE DUCT STONE CONTAINING A METALLIC CLIP APPEARING 13 YEARS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

We report herein on an octogenarian woman who underwent laparoscopic cholecystectomy for cholelithiasis in 1998. She was hospitalized for a examination of upper quadrant pain and nausea in November, 2010. Her biliary system enzyme levels were elevated and she had hepatic dysfunction. Abdominal contrast CT showed dilation of the biliary duct and revealed common bile duct stone with extremely high density on the images. We diagnosed the patient as having a common bile duct stone containing a metallic clip. We started conservative medical treatment because she had no signs of infection and prescribed an antithrombocytic agent. Endoscopic retrograde cholangiography was undertaken on the seventh post-admission day. It showed the common bile duct stone including the metallic clip in the dilated portion of the biliary duct. We performed endoscopic papillotomy and the stone was removed using a basket catheter and a balloon catheter. The patient was discharged without complications on the ninth post-admission day. Though we reduced the size of the clip with an ultrasonic cutting and coagulating system during the laparoscopic cholecystectomy procedure, the common bile duct stones containing the clips occurred. We present this case with a review of the literature, because it is a comparatively rare complication.