2017 Volume 59 Issue 8 Pages 1632-1637
A 74-year-old male with a history of laparoscopic cholecystectomy and endoscopic sphincterotomy 9 months previously at our hospital was referred to our department because of elevated liver function test. Computed tomography scan of the abdomen showed a linear metallic density artifact in the common bile duct. Endoscopic retrograde cholangiography revealed an endo clip lodged in the dilated distal common bile duct. The patient was managed successfully by endoscopic clip removal. Surgical clip migration following cholecystectomy is a rare but well-documented complication with several published case reports. The exact pathophysiological process by which this occurs is not clearly understood. Many factors may contribute to clip migration, including inaccurate clip placement with resultant bile duct injuries, ineffective closure of the cystic duct by endo clips with bile leak, biloma formation and local infective process around the clip, and cholecystectomy in the setting of acute cholecystitis and pancreatitis. Sixty-four cases of clip migration have been reported in the Japanese literature since 1992. Twelve cases (26.6％) of clip migration into the common bile duct after laparoscopic cholecystectomy including the present case had complications of bile duct injuries, massive bleeding and/or bile peritonitis during or immediately after the initial operation. Eight cases (12.3％) needed to undergo resection of the bile duct because of stricture of the bile duct. This statistic indicates that complications during and immediately after cholecystectomy are high risk factors for clip migration. If there is a high probability of clip migration after cholecystectomy, it is important to follow the patient closely to avoid resection of the bile duct.
