Choledocholithiasis And Acute Cholangitis Following PostCholecystectomy Clip Migration

Agraj Tripathi, R. Rai
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Abstract

Laparoscopic cholecystectomy is the standard of care in symptomatic cholelithiasis and it has been associated with complications such as bile duct injury, bleeding, bile leak and residual stones. Postcholecystectomy clip migration is an uncommon complication of laparoscopic cholecystectomy . It was first reported in 1992. We present a case report of a 48 years old lady presenting with right upper abdominal pain fever and vomiting. Patient had undergone an uncomplicated laparoscopic cholecystectomy 13 years earlier. Magnetic resconance cholangiopancreatography revealed non-visualization of lower common bile duct, thick bile and proximal dilatation. Patient was successfully managed with Endoscopic retrograde cholangiopancreatography to remove the stone with along with clip. Long-term follow-up should be done in post-cholecystectomy patients and cystic duct clip migration with eventual biliary complications should be considered as a differential diagnosis in symptomatic post-cholecystectomy patients.
胆管结石和急性胆管炎后胆囊切除术夹移动
腹腔镜胆囊切除术是治疗症状性胆石症的标准治疗方法,但常伴有胆管损伤、出血、胆漏和残余结石等并发症。胆囊切除术后夹片移位是腹腔镜胆囊切除术中一种罕见的并发症。首次报道是在1992年。我们提出一个病例报告,48岁的妇女表现为右上腹部疼痛,发烧和呕吐。患者13年前曾做过简单的腹腔镜胆囊切除术。磁共振胆管造影显示胆总管下段未见,胆厚及近端扩张。患者成功地通过内镜逆行胆管造影,连同夹子取出结石。胆囊切除术后患者应进行长期随访,对于有症状的胆囊切除术后患者,应考虑将胆囊管夹移位最终导致胆道并发症作为鉴别诊断。
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