Chandan Dash, MBBS, MD1, Sheena Mago, DO2, Abhijit Kulkarni, MD3, Himsikhar Khatanair, MBBS, MD3, Kojo-Frimpong B. Awuah, MD4, Harendra Kumar, MBBS5 1Allegheny Health Network Medicine Institute, Pittsburgh, PA; 2Allegheny Health Network, Pittsburgh, PA; 3Allegheny Center for Digestive Health, Pittsburgh, PA; 4Allegheny General Hospital, Pittsburgh, PA; 5Dow University of Health Sciences, Karachi, Sindh, Pakistan
Introduction: The most common causes of obstructive jaundice are choledocholithiasis and malignant biliary strictures. Migration of surgical clips are a rare complication of cholecystectomies and can serve as nidus for stone formation in the biliary tree which can lead to complications such as choledocholithiasis or cholangitis.
Case Description/Methods: A 53-year-old female with history of laparoscopic cholecystectomy 8 years ago presented with 2 months of gradually worsening intermittent upper abdominal pain, nausea and non-bloody emesis. Physical examination was significant only for mild right upper quadrant tenderness. Laboratory results revealed an elevated aspartate transaminase 1545 U/L, alanine transaminase 769 U/L, elevated alkaline phosphatase 397 U/L, elevated gamma-glutamyl transferase 508 U/L, and elevated total bilirubin 1.5 mg/Dl. Abdominal computed tomography showed evidence of a prior cholecystectomy with a common bile duct (CBD) diameter of 9 mm containing a 4 mm distal stone along with an apparent surgical clip adjacent to the ampulla of vater. Subsequent ERCP with injection of contrast revealed a metallic foreign object within an area of filling defect in the middle third of the CBD. The ducts were swept revealing a stone with an imbedded surgical clip with ultimate improvement in patient’s symptoms and labs.
Discussion: Choledocholithiasis from migration of surgical clips post cholecystectomy is a rare complication. The exact mechanism of clip migration is unclear; however, risk factors include clip placement technique, complicated gallstone disease, and distorted anatomy. This case highlights a rare complication of cholecystectomy and should be considered when evaluating patients presenting with symptoms biliary colic who have had prior surgery.
Figure: 1. ERCP image of CBD stone, 2. CT abdomen image of the migrated clip, 3. Stone with the clip after stone retrieval
Disclosures:
Chandan Dash indicated no relevant financial relationships.
Sheena Mago indicated no relevant financial relationships.
Abhijit Kulkarni indicated no relevant financial relationships.
Himsikhar Khatanair indicated no relevant financial relationships.
Kojo-Frimpong Awuah indicated no relevant financial relationships.
Harendra Kumar indicated no relevant financial relationships.
Chandan Dash, MBBS, MD1, Sheena Mago, DO2, Abhijit Kulkarni, MD3, Himsikhar Khatanair, MBBS, MD3, Kojo-Frimpong B. Awuah, MD4, Harendra Kumar, MBBS5. P3594 - Clip-Choledocholithiasis: A Case of Migrated Surgical Clip Causing Choledocholithiasis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
