Foreign bodies in common bile duct in post cholecystectomy status—case series of 8 cases—A single center experience in western India

Abstract

Foreign bodies in common bile duct (CBD) are rare. Obstructive jaundice in patients who have undergone cholecystectomy may be due to a variety of causes. Common causes of obstruction in these cases are residual stones, inflammatory or ischaemic strictures following CBD injury during cholecystectomy or malignant strictures. Foreign bodies in the bile duct in these post cholecystectomy patients are known but reported very rarely. Clinical features and biochemistry of these patients are no different than those due to other causes mentioned above. Imaging studies will show obstruction due to stones or sludge or narrowing but may not give conclusive diagnosis of a foreign body. Endoscopic ultrasound is helpful in these cases as it shows a hyperechoic foreign body within the stone if the substance is a metallic clip. In our current case series, we are presenting eight such cases with post cholecystectomy foreign bodies, in the form of materials used for ligating or clipping the cystic duct before transection during cholecystectomy, or a mistakenly left behind gauze piece, migrating into the bile duct and forming a nidus for stone formation and causing CBD obstruction. To conclude, if a patient presents with biliary obstruction with a history of cholecystectomy, the possibility of foreign body in the CBD must be considered as a possible differential diagnosis.

The most frequent symptoms of postcholecystectomy syndrome for cholelithiasis patients older than 40 years of age

“…Therefore, the clinical picture of common symptoms in PCS includes right hypochondriac pain, abdominal distension, and gastrointestinal issues, which may last more than 2 days following cholecystectomy. 3,4 For instance, Espinosa Brito et al 5 and Schofer 6 concur that postcholecystectomy complaints resemble the clinical symptoms of PCS, particularly dyspepsia and pain in the upper right quadrant of the abdomen, which were seen in 5% to 40% of all patients. While Shirah et al 7 notes that these symptoms might develop slowly over months or years following cholecystectomy and are regarded as late symptoms, they can also develop almost immediately after surgery and are referred to as early symptoms.…”

Migration of a Retained Surgical Suture Needle in the Common Bile Duct

“… The patient underwent a biopsy, which revealed a 1.7 cm curved, linear, rusty, metallic surgical suture needle containing bile. A retained surgical item poses a hazard to surgical safety and occurs occasionally despite various systems and safeguards [ 1 , 2 , 3 ]. Any surgical material, including tools, supplies, and equipment, can inadvertently be left inside a patient’s abdomen and can cause subsequent harm to the patient.…”

“…However, our patient developed symptoms and signs of a retained needle 28 years after his surgery, by which point the needle had migrated to the ampulla of vater, from where it was easily removed through ERCP. Migrated surgical clips, stents, gauze pieces, suture materials, and fragments of t-tubes have all been reported as retained iatrogenic foreign bodies causing CBD obstruction and subsequent sequelae [ 2 ]. To our knowledge, this is the first reported case in which a retained surgical needle migrated to the ampulla of vater.…”