Migration of a Hem-O-Lok clip into the cecal lumen following laparoscopic appendectomy: a case report.

Background: Hem-O-Lok clips are widely used in laparoscopic appendectomy (LA). Although postoperative clip migration is rare, it is a clinically significant complication. Previous reports have mainly focused on clip migration after cholecystectomy and urologic surgery. To the best of our knowledge, there have been no reports of clip migration into the intestinal lumen after LA. This report suggests that such migration may occur after LA, highlights an important potential device-related complication, and adds to the relevant literature.

Case presentation: A 44-year-old male experienced persistent dull right lower abdominal pain for three days, two months after LA. Physical examination showed tenderness at McBurney's point, while laboratory tests revealed no abnormalities. The patient had received two Hem-O-Lok clips during surgery two months prior. Abdominal computed tomography (CT) revealed a high-density shadow in the ileocecal region. Colonoscopy confirmed a Hem-O-Lok clip embedded at the appendiceal orifice within the cecal lumen. The patient refused endoscopic removal, opting for conservative observation. At the six-month follow-up, the patient's pain had completely resolved.

Clinical discussion: The mechanism of this complication remains unclear and may involve the combined effects of local inflammation and foreign body-related reaction. CT may serve as an initial screening tool, and endoscopy is helpful for establishing the diagnosis. As there is currently no standardized treatment strategy, conservative observation, endoscopic intervention, and surgical treatment may all be considered as options, depending on the individual situation. In clinical practice, attention should also be paid to the standardized use of clips in order to reduce the risk of similar complications.

Conclusion: This case highlights the potential risk of Hem-O-Lok clip migration after LA. Clinicians should increase their awareness of this rare complication.