A Case of Clip Migration to the Common Bile Duct After Laparoscopic Cholecystectomy

Abstract

An 82-year-old woman had been treated for acute cholangitis by endoscopic papillotomy and biliary drainage 35 days earlier. She subsequently underwent laparoscopic cholecystectomy (LC) as radical treatment for bile duct stones, and the cystic duct was clipped with a Hem-o-lok ligation system. She was discharged on postoperative day 4. On day 47, the biliary stent was removed and a filling defect measuring 8 mm in size was observed in the lower common bile duct. The object occupying the defect area was removed endoscopically and was identified as the Hem-o-lok clip used for LC. Clip migration after LC has been reported rarely, although the cause remains unclear. A large percentage of patients with clip migration have biliary occlusion. Although clip migration is diagnosed within the first postoperative year in most cases, it is sometimes diagnosed later in the clinical course. Clip migration can occur at any time after LC, and when it is detected, endoscopic treatment should be considered.