Hem-o-Lok clip migration into renal pelvis and stone formation as a long-term complication following laparoscopic pyelolithotomy: a case report and literature review

Abstract

Background Hem-o-Lok clips (HOLCs) are widely used in minimal access urological operations due to the advantage of vascular control and suture stabilization. In rare cases, however, they can develop problems themselves. Migration of HOLCs into the collecting system is a fairly rare complication after laparoscopic pyelolithotomy. To date, only two cases were reported in the literature. Case presentation This article describes a case of 51-year-old man with a complaint of left flank pain. He had a medical history of ipsilateral retroperitoneal laparoscopic pyelolithotomy at another hospital 8 years ago. Non-contrast CT scan demonstrated a renal stone in the left ureteropelvic junction complicated by mild hydronephrosis. A straight foreign body was found near the renal pelvis, with part of it wedging into renal pelvic wall. A percutaneous nephrolithotomy (PNL) was performed for this patient. After some fragmentation, a HOLC was found in the kernel of the stone. With an alligator plier, the clip was totally removed out of the collecting system. The postoperative period and follow-up were uneventful. Conclusions HOLC migration into renal pelvis is a rare complication following laparoscopic pyelolithotomy. It could act as nidus for stone formation under extended exposure to urine. Using HOLCs to stabilize the anastomotic suture near renal pelvis should be avoided to prevent this complication. Instead, knotting is a better choice under such condition. The secondary calculi and dislodged HOLCs can be removed through PNL by an alligator plier after laser lithotripsy.

An unexpected gastric submucosal mass-like lesion

“…The final pathological examination of the mass revealed a reactive nodular fibrous pseudotumor. The Hem-o-lok clip is used frequently during laparoscopic procedures, and a few case reports of clip migration have been published [1][2][3][4]. In our case, the patient was asymptomatic and the clip was found in an endoscopic resection of the mass-like lesion, which is a rare report.…”

Urolithiasis secondary to Hem-o-lok partial migration into renal calyx as a long-term complication of robotic partial nephrectomy: a case report and literature review

“…Unfortunately, as some other foreign bodies, they could migrate into the collecting system and be calculogenic [3]. Their migration into the urinary tract could be due to different factors: too much tension of the parenchymal suture, delayed healing such as in chronic kidney disease or diabetes, the violation of the collecting system during the enucleation or the chronic erosion of the renal parenchyma [4,5]. The management of urolithiasis secondary to HOLC migration into the urinary tract has been described by many authors and consists in endoscopic stone fragmentation and removal of the HOLC [6,7].…”

Incidental Finding of Intrarenal Foreign Guidewire During Percutaneous Nephrolithotomy: A Case Report and Literature Review

“…Guidewire fragments may simply penetrate and embed the renal parenchyma with their sharp edges. Several hypotheses have been proposed for patients whose prior procedure involved anastomosis: (1) excessive suture tension promotes chronic continuing erosion [ 13 ]; (2) delayed anastomotic site healing due to underlying chronic renal disease and diabetes [ 14 ]; and (3) erosion occurring alongside sheer stress within the body [ 15 ]. Atypical presentations, such as a foreign body granuloma mimicking renal tumor, have also been documented [ 16 ].…”