Post-laparoscopic cholecystectomy Mirizzi syndrome induced by polymeric surgical clips: a case report and review of the literature

Abstract

BackgroundLaparoscopic cholecystectomy is the gold standard treatment of gallbladder disease. Post-cholecystectomy syndrome is a severe postoperative complication which can be caused by multiple mechanisms and can present with multiple disorders. The wide use of laparoscopy induces the need to understand more clearly the presentation and pathophysiology of this syndrome. Post-cholecystectomy Mirizzi syndrome is one form of this syndrome and, according to literature, this is the first report that clearly describes it.Case presentationWe describe the case of a 62-year-old Greek woman who underwent laparoscopic cholecystectomy because of gallstone disease. A few days after surgery, post-cholecystectomy syndrome gradually developed with mild bilirubin increase in association with epigastric pain, nausea, and vomiting. After performing ultrasound, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography, we conducted a second laparoscopic surgery to manage the obstruction, which was converted to open surgery because of the remaining inflammation from the post-endoscopic retrograde cholangiopancreatography acute pancreatitis. Four polymeric laparoscopic clips were removed because they were identified as the cause of her post-cholecystectomy syndrome. She had a quick recovery without further complications.ConclusionsPostoperative Mirizzi syndrome induced by the migration of polymer laparoscopic clips is a rare (only one case referring to polymeric clips has been published in the literature) but a well-identified complication of laparoscopic cholecystectomy which can confuse the diagnostic and therapeutic field requiring simultaneous immediate management.

The Safety and Efficacy of Clipless versus Conventional Laparoscopic Cholecystectomy – our Experience in an Indian Rural Center

“…Photi ES et al (20) have done the ligation of the cystic duct with surgical clips, and reported a case of cholan gitis secondary to clip migration into the CBD. Another case was reported as postoperative Mirizzi syndrome caused by the migration of four polymer laparoscopic clips, which could confuse the diagnostic and therapeutic field for treatment (21). A study reported a case of bile leak caused by an injury to the ducts of Luschka after LC; the leak was treated with ES using 5-F NBT, and the resolution of the leak was confirmed without repeated endoscopy (22).…”

Late postcholecystectomy Mirizzi syndrome due to a sessile gall bladder remnant calculus managed by laparoscopic completion cholecystectomy: a feasible surgical option

“…PCS comprises a heterogeneous group of symptoms and signs in a patient after cholecystectomy 1. Its overall incidence is 10%–40% with female preponderance (43% in women versus 28% in men) 2. It has been reported from 2 days to 32 years after cholecystectomy 3.…”

“…Biliary causes such as retained or recurrent biliary calculi with/out cholecystitis, biliary stricture, biliary dyskinesia and biliary leaks cause early or late PCS less frequently as compared with extrabiliary causes. Among all biliary causes of late PCS, postcholecystectomy Mirizzi syndrome (PCMS) is extremely rare 1–3. It is often misdiagnosed and difficult to manage.…”

“…PCMS can occur due to cystic duct stump calculus or gall bladder remnant calculus. The role of laparoscopy in its management is controversial 1–4. We present a case wherein, laparoscopic completion cholecystectomy (LCC) was performed for PCMS due to gall bladder remnant calculus, review the literature and summarise our algorithmic approach to the management of PCS.…”

Review of imaging in post-laparoscopy cholecystectomy complications

“…A rare cause of post-cholecystectomy Mirizzi syndrome is laparoscopic clip migration, which can lead to secondary inflammation and stricture formation. [ 12 ]…”