Migration of a Surgical Clip Into the Common Bile Duct and Its Spontaneous Passage.

Abstract

Cholecystectomy is one of the most commonly performed surgical operations worldwide. A rare complication following this procedure is the migration of surgical clips used to secure the cystic duct and artery. Herein, we report the migration of a metallic surgical clip into the common bile duct of a 75-year-old gentleman who underwent a laparoscopic cholecystectomy 24 years prior. He presented to the hospital three times over the course of six months with the predominant symptoms of right upper quadrant pain. His symptoms improved with supportive care during his first two admissions, and he was discharged home with a plan for ongoing investigation. Subsequent endoscopic ultrasound and magnetic resonance imaging did not identify a cause for his symptoms. On his third presentation to the hospital, he had mild transaminitis with elevated bilirubin and his computed tomography scan revealed migration of a surgical clip into the distal common bile duct where it was causing obstruction. As he was also symptomatic with influenza A and at a heightened anaesthetic risk, a conservative management approach was taken instead of upfront endoscopic retrograde cholangiopancreatography for clip retrieval. Over the coming days, his bilirubin and liver function tests began to normalise and the offending clip was not identified on a repeat computed tomography scan performed three days later, indicating spontaneous passage of the clip from the common bile duct. On re-review of the initial imaging, the surgical clip can be seen within the remnant cystic duct prior to its migration into the distal common bile duct. Surgical clip migration is an exceedingly uncommon occurrence, and this case highlights the difficulty of establishing the diagnosis despite extensive investigation. Increased awareness of this phenomenon among clinicians will hopefully aid in earlier diagnosis and improved outcomes for patients.