An 82‐year‐old woman who had undergone cholecystectomy 10 years earlier presented with a 2‐day history of acute abdominal pain. Physical examination revealed epigastric tenderness with rebound. Laboratory findings showed elevated levels of C‐reactive protein (8.24 mg/dL), alanine aminotransferase (756 U/L), aspartate aminotransferase (740 U/L), and lactate dehydrogenase (754 U/L). Total bilirubin (2.11 mg/dL) and gamma‐glutamyl transferase (842 U/L) levels were also elevated. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, serological tests for Epstein–Barr virus, hepatitis B virus, and hepatitis C virus were negative. Blood cultures showed no growth and all tumor markers were within the normal range. Computed tomography revealed a metallic density lesion inside the common bile duct (Figure 1A,B, arrowheads). Thus, the patient was diagnosed with cholangitis due to post‐cholecystectomy clip migration (PCCM). Endoscopic retrograde cholangiopancreatography was performed; however, the clip was no longer visible and could not be retrieved. The patient was managed conservatively. Her symptoms and laboratory abnormalities gradually resolved, and serial abdominal radiographs showed progressive passage of the clip over 2 days (Figure 1C,D, arrowheads). PCCM is a rare cause of cholangitis [1]. Although the mechanism remains uncertain, one proposed explanation is inversion of the cystic duct stump into the common bile duct due to pressure from the liver, resulting in ischemic necrosis and clip migration [2]. Another hypothesis is that improper clip placement leads to bile leakage and local inflammation, causing erosion of the bile duct wall and subsequent migration [3]. In patients with a history of cholecystectomy, PCCM should be considered in the differential diagnosis of cholangitis.
FIGURE 1.
Post‐cholecystectomy clip migration causing transient cholangitis. (A, B) Computed tomography images showing a metallic‐density lesion within the common bile duct (arrowheads). (C, D) Serial abdominal radiographs demonstrating progressive passage of the migrated clip (arrowheads).
Author Contributions
Hirotaka Yamamoto: conceptualization, investigation, data curation, visualization, writing – original draft, writing – review and editing. Masafumi Kawamura: investigation. Yoshinori Taniguchi: investigation, supervision.
Funding
The authors have nothing to report.
Ethics Statement
The authors have nothing to report.
Consent
Written informed consent was obtained from the patient for publication of this clinical image and the accompanying text.
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.