A 90-year-old woman experienced epigastric pain 3 months after laparoscopic cholecystectomy for acute cholecystitis. Laboratory tests showed elevated concentrations of pancreaticobiliary enzymes. Radiography and computed tomography with three-dimensional reconstruction imaging of the biliary tract revealed post-cholecystectomy clip migration (PCCM) in the common bile duct (Picture 1, 2) and mild pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and a biliary stone including the clip was found to have moved from the common bile duct to the duodenal lumen (Picture 3). Computed tomography the day after ERCP revealed the clip to be in the ascending colon (Picture 4). Although PCCM is a rare complication (1), it causes biliary stone formation, which reportedly develops early to several decades after cholecystectomy. There are various theories about the mechanism underlying the occurrence of PCCM. In this case, the inflammatory state after acute cholecystitis might have caused the PCCM (2). Cholecystectomy using absorbable thread instead of clips may prevent this complication.
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The authors state that they have no Conflict of Interest (COI).
Acknowledgement
We thank Angela Morben, DVM, ELS, for editing a draft of this manuscript.
References
- 1. Cetta F, Baldi C, Lombardo F, Monti L, Stefani P, Nuzzo G. Migration of metallic clips used during laparoscopic cholecystectomy and formation of gallstones around them: surgical implications from a prospective study. J Laparoendosc Adv Surg 7: 37-46, 1997. [DOI] [PubMed] [Google Scholar]
- 2. Chong VH, Chong CF. Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases. J Gastrointest Surg 14: 688-696, 2010. [DOI] [PubMed] [Google Scholar]