Cholangitis caused by surgical clip migration into the common bile duct: a rare complication of a daily practice

Sheffer, Daniel B.; Oren, Gal; Ovadia, Baruch; Kopelman, Yael

doi:10.1136/bcr-2019-231201

Cited by 6 publications

(2 citation statements)

References 15 publications

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“…Surgical clip migration after laparoscopic cholecystectomy was first reported in 1992 [2]. The literature suggests that clip migration can occur at any time, varying from 11 days to 20 years, with a median of two years [3]. The most common site of migration is into the CBD [4], where they can promote stone formation [3].…”

Section: Discussionmentioning

confidence: 99%

“…The literature suggests that clip migration can occur at any time, varying from 11 days to 20 years, with a median of two years [3]. The most common site of migration is into the CBD [4], where they can promote stone formation [3]. Other complications associated with clip migration include biliary colic, obstructive jaundice, cholangitis, and acute pancreatitis [4].…”

Section: Discussionmentioning

confidence: 99%

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Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy

Yin,

Goh,

Mohd Rosli

et al. 2023

Cureus

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Surgical clip migration post-laparoscopic cholecystectomy is a rare but important complication to consider in patients presenting with biliary obstruction. Titanium surgical clips are widely used in laparoscopic surgery to ligate vessels and ducts and are particularly important in laparoscopic cholecystectomy to ligate the cystic duct. More common complications associated with clips involve dislodgement, however, there are reported cases of migration into visceral structures causing an obstruction. We describe a case that demonstrated an acute migration of surgical clips into the common bile duct (CBD) within a three-week period, which occurred 32 years after laparoscopic cholecystectomy, likely attributed to erosion. On the patient's first presentation, she had acute pancreatitis with a CT demonstrating clips in the correct position. Three weeks later, the patient presented a second time with acute cholangitis and the repeat CT demonstrated the clips in the CBD. We hypothesize that the erosion of the bile duct is due to the pressure effects from either intra-abdominal organ movements or subtle clip movements, and eventually, persistent erosion leading to intra-ductal migration of the clips with the passage of the clips along the path of least resistance into the CBD, resulting in biliary obstruction. Management included standard treatment for biliary obstruction with intravenous broad-spectrum antibiotics and endoscopic retrograde cholangiopancreatography with excellent outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy

Yin,

Goh,

Mohd Rosli

et al. 2023

Cureus

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Post-operative complications of cholecystectomy: what the radiologist needs to know

Kazi,

Siddiqui,

Thimmappa

et al. 2024

Abdom Radiol

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Cholecystectomy is one of the most performed surgical procedures. The safety of this surgery notwithstanding, the sheer volume of operations results in a notable incidence of post-cholecystectomy complications. Early and accurate diagnosis of such complications is essential for timely and effective management. Imaging techniques are critical for this purpose, aiding in distinguishing between expected postsurgical changes and true complications. This review highlights current knowledge on the indications for cholecystectomy, pertinent surgical anatomy and surgical technique, and the recognition of anatomical variants that may complicate surgery. The article also outlines the roles of various imaging modalities in identifying complications, the spectrum of possible postsurgical anatomical changes, and the implications of such findings. Furthermore, we explore the array of complications that can arise post-cholecystectomy, such as biliary system injuries, gallstone-related issues, vascular complications, and the formation of postsurgical collections. Radiologists should be adept at identifying normal and abnormal postoperative findings to guide patient management effectively. Graphical abstract

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Surgical clip migration following laparoscopic cholecystectomy: A rare cause of acute cholangitis

Mizouni

Ammar

Said

et al. 2020

Annals of Medicine and Surgery

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Clip migration following laparoscopic cholecystectomy (LC) is a rare and late complication of LC. The first case of surgical clip migration after LC was reported in 1992, and since then less than 100 cases have been reported in the literature. We report the case of cholangitis secondary to a surgical clip migration in an 83 years old male patient, 8 years after LC. Contrast-enhanced computed tomography of the abdomen (CT) showed intra and extrahepatic ducts dilatation secondary to a hyperdense object located in the distal common bile duct (CBD). It was removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after sphincterotomy. At the last follow-up of one year after her admission, the patient is symptom-free with normal liver enzyme and abdominal CT. Surgical clip migration into CBD, should be included in the differential diagnosis while treating patients with the past surgical history of LC. Early diagnosis and treatment of this complication can avoid serious complications.

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Cholangitis caused by surgical clip migration into the common bile duct: a rare complication of a daily practice

Cited by 6 publications

References 15 publications

Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy

Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy

Post-operative complications of cholecystectomy: what the radiologist needs to know

Surgical clip migration following laparoscopic cholecystectomy: A rare cause of acute cholangitis

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