to maintaining your privacy and will not share your personal information without 4. Nous 7-15). You may be trying to access this site from a secured browser on the server. Surgical clips are applied during cholecystectomy on the cystic duct and artery. Clip migration within the common duct after laparoscopic cholecystectomy: a case of transient acute pancreatitis in the absence of associated stones. Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Descottes adhérons aux principes de la charte HONcode. The symptoms may include abdominal pain, nausea, vomiting, anorexia, pruritus, jaundice and fever due to ascending cholangitis [3, 4, 7]. On comparison with a chest CT performed 1 month earlier for assessment of an organizing pneumonia, a cholecystectomy clip had since migrated from the gallbladder fossa through the cystic duct stump into the CBD. Wolters Kluwer Health Postcholecystectomy clip migration was first described in the literature in 1978.1 Clips may migrate via the biliary tree, via a duodenal ulcer, or even by a clip embolism.2 Risk factors for postcholecystectomy clip migration include cholecystectomies with more than 4 surgical clips, previous complicated gallstone disease, inaccurate clip placement, and distorted anatomy.2 The pathophysiology is thought to be related to cystic stump necrosis and movement of the clip to a low-pressure system via the CBD.3 Management options include ERCP, percutaneous biliary cholangiogram (PTC) with biliary drain placement, and surgery.2,4 ERCP is the preferred mode of removal because even when not initially successful, it can allow for delayed spontaneous passage.2 The patient's blood cultures were negative, and he was discharged home on a course of antibiotics with resolution of all symptoms. Background . Since its introduction, surgical hemostatic clips have been widely used and are generally considered very safe. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Sanders, David BSc, MD1; Murray, Timothy MD, MCh, MRCS, FFR, EBIR2; Byrne, Michael F. MA, MD, MRCP, FRCPC1, 1Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada, 2Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada. symptoms even many years after cholecystecto- ... (13) found that post-cholecystectomy clip migration was rare, but could lead to complications such as clip-related biliary stones. 1995;90(9):1521–4. Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Register with us for free The delay between laparoscopic cholecystectomy and the first symptoms due to cystic duct clip migration ranged from 5 to 12 months. Lippincott Journals Subscribers, use your username or email along with your password to log in. T. Murray provided the images. Durand-Fontanier Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. The time of clip migration can vary from 11 days to 20 years, while the median time of migration is usually 2 years and the median number of the migrated clip is 1 (range 1–6) [ 3 ]. Am J Gastroenterol. Clip migration into the common bile duct can cause recurrent cholangitis and serve as a nidus for stone formation. Balloon sphincteroplasty was performed, and the cholecystectomy clip and adherent sludge were successfully removed via a balloon sweep (Figure 3). 1. Rarely one or more clips can get displaced. Surgical clip migration is an uncommon complication of laparoscopic cholecystectomy, which may occur days to years following surgery. We present herein the case of a woman who developed unexpected complications following a laparoscopic cholecystectomy. By continuing to use this website you are giving consent to cookies being used. The common clinical symptoms of clip migration are right upper abdominal pain (approximately 70%–80% of cases), jaundice (approximately 50%–75%) and fever (approximately 30%). Your message has been successfully sent to your colleague. For more information, please refer to our Privacy Policy. Cetta F, Lombardo F, Baldi C, Cariati A. It should be considered in the differential diagnosis of postcholecystectomy biliary colic and cholangitis. 1 public playlist include this case. His temperature was 38.5°C, and his white blood cell count was 6.0 × 109 cells/L. This clip caused choledocholithiasis in a patient 1 year after a laparoscopic cholecystectomy. It was reported 2 Raoul JL, Bretagne JF, Siproudhis L, Heresbach D, Campion that the time of endoclips to migrate into the bile ducts JP, Gosselin M. Cystic duct clip migration into the common bile duct: a complication of laparoscopic cholecystectomy after LC is between 11 d and 6 years[2,6,7,15,16]. Biliary complications secondary to post-cholecystectomy clip migration: A review of 69 cases. Suspecting ascending cholangitis secondary to an obstructing migrated cholecystectomy clip, fluid resuscitation and broad-spectrum antibiotic coverage were commenced and ERCP was performed. This study reviews a case of postcholecystectomy clip migration. to save searches, favorite articles and access email content alerts. La présence de clips au niveau de la voie biliaire principale peut résulter de leur mauvais positionnement lors de l'intervention, ou d'une migration secondaire. The common clinical symptoms of PCCM were right upper abdominal pain, jaundice, fever and rare cases included pyaemia and shock [Table 2]. Most of the complications and risks carried by cholecystectomy are minimal and can be reversed or fixed.Long term complications are minimal, but very detailed in nature Studies showed that acute biliary obstruction with laparoscopic cholecystectomy is twice as common as acute biliary obstruction with open cholecystectomy because of misplaced or migrating surgical clips [ 8 ]. Approximately 20 to 40 % of … Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Some error has occurred while processing your request. Initial investigations confirmed pyrexia and elevated bilirubin. All rights reserved. tomy or laparoscopic cholecystectomy, clip migration or suture knot migration should be considered as a cause of recurrent painful symptoms in the right upper quadrant. ,  ,  It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Author contributions: D. Sanders wrote the manuscript, reviewed the literature, and is the article guarantor. Our case shows that in case of recurrence of symptoms following cholecystectomy, clip migration should be considered in one ofthe differential diagnosis. This is usually 'dropped' during this laproscopic procedure. Most of such incidents have been reported as case reports. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Informed consent was obtained for this case report. Symptoms were due to the obstruction of the common bile duct by the clip, and corresponded to acute non-suppurative cholangitis in two cases and to isolated pain in the other two. We present the case of a patient who presented with signs and symptoms of cholangitis due to clip migration one year after laparoscopic cholecystectomy; endoscopic retrograde … migration of the clip through the wall of these organs or the surgical stump. All registration fields are required. Case Report. Both an index episode and a recurrence of acute pancreatitis (AP) should prompt a search for the inciting cause to prevent potential future AP episodes and further damage to the pancreas. We hope that this case draws … Please enable scripts and reload this page. © 2000  Although some physicians may abruptly rule out biliary causes of AP after a cholecystectomy, gallstones, sludge, and surgical complications should still be considered. We present a case, a 54-year-old woman, of clip-induced cholangitis resulting from surgical clip migration 12 months after laparoscopic cholecystectomy and laparoscopic common … The median number of the migrated clip was one (range 1–4), and the common migration is to CBD and duodenum [Table 2]. This study reviews a case of postcholecystectomy clip migra-tion. In one patient, the clip dropped from the duodenum after 2 months; the … 2. 2010;14(4):688–96. Cholecystectomy was performed after cholangiography. D.  Common diagnoses at presentations of PCCM were obstructive jaundice (37.7%), cholangitis (27.5%), biliary colic (18.8%), and acute pancreatitis (8.7%). Cholecystectomy is one of the most common … Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases | springermedizin.de Registrieren Login 800-638-3030 (within the USA), 301-223-2300 (outside of the USA) We present herein the case of a woman who developed unexpected complications following a laparoscopic cholecystectomy. tion3 post-laparoscopic cholecystectomy, as well as migra-tion to more remote and dependent organs like ovary and causing symptoms.4 References 1. 10 The first case of PCCM was reported in 1978. Conflict of Interest The author declares no conflict of interest related to this work. The clinical manifestations were unique in that symptoms of obstructive jaundice were in fact caused by endo-clips which had migrated into the common bile duct, and the resulting choledochoduodenal fistula presented as persistant cholangitis. The mechanism and exact incidence of clip migration are both poorly understood. your express consent. S.  Cholangitis with a silver lining. Studies showed that acute biliary obstruction with laparoscopic cholecystectomy is twice as common as acute biliary obstruction with open cholecystectomy because of misplaced or migrating surgical clips [ 8 ]. Migration of surgical clips is a rare complication of laparoscopic cholecystectomy, which can be a cause of iatrogenic Mirizzi syndrome . 2. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Lippincott Journals Subscribers please login with your username or email along with your password. Correspondence: David Sanders, BSc, MD, Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1L9 ([email protected]). Wolters Kluwer Health, Inc. and/or its subsidiaries. Enter and submit the email address you registered with. Metallic clip migration in most cases is due to technical factors and can usually be prevented. Article gratuit. For immediate assistance, contact Customer Service: Arch Surg. 3. The common clinical symptoms of clip migration are right upper abdominal pain (approximately 70%–80% of cases), jaundice (approximately 50%–75%), and fever (approximately 30%) [3,6]. B.  Endoscopic retrograde cholangiopancreatography showing the common bile duct (triangle) and surgical clip (arrow). Clip-induced biliary stone. Conflict of Interest The author declares no conflict of interest related to this work. The clip itself may cause those symptoms without the formation of a stone, usually if the migration occurs within 3 months after the operation. Chong VH, Yim HB, Lim CC. Computed tomography image showing the common bile (triangle) and surgical clip (arrow). Item Preview Tous droits réservés. During LC, surgical hemostatic clips placed on the cystic duct and … Please try again soon. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers. Multiple cholecystectomy clip migration into the common bile duct causing obstructive jaundice His medical history was notable for a laparoscopic cholecystectomy for symptomatic cholelithiasis 6 years ago. 1 Most of such incidents have been reported as case reports. Migration of the clips into the common bile duct can lead to stone formation and obstruction. MF Byrne reviewed the manuscript. Gastroscopy revealed metal clips in the duodenum. The clip was then extracted from the patient by using clip forceps (Figure 4). En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Migration of Clips after Laparoscopic Cholecystectomy; A Case Report and Literature Review ABSTRACT Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Bienvenue sur EM-consulte, la référence des professionnels de santé. The clinical manifestations were unique in that symptoms of obstructive jaundice were in fact caused by endo-clips which had migrated into the common bile duct, and the resulting choledochoduodenal fistula presented as persistant cholangitis. The term postcholecystectomy syndrome (PCS) describes the presence of symptoms after cholecystectomy. Please try after some time. ,  Registered users can save articles, searches, and manage email alerts. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. Surgical clip migration into the common bile duct (CBD) is a rare complication after laparoscopic cholecystectomy (LC) [1, 2]. Pain was due either to biliary colic or to acute pancreatitis (case 2). 30 mins. Éditions scientifiques et médicales Elsevier SAS. 2004;45(11):533–5. September 2019; The American Journal of Gastroenterology; DOI: 10.14309/crj.0000000000000216 The work cannot be changed in any way or used commercially without permission from the journal. Sorry, the specified email address could not be found. Surgical clips are applied during cholecystectomy on the cystic duct and artery. may email you for journal alerts and information, but is committed Most of such incidents have been reported as case reports. Financial disclosure: MF Byrne is the CEO and shareholder of Satis Operations Inc. Rarely one or more clips can get displaced. Clip; Common Bile Duct Stone; Laparoscopic Cholecystectomy; Migration . At the time of current acute presentation, an abdominal CT demonstrated moderate biliary dilatation down to the level of a thin metallic intraluminal density within the common bile duct (CBD) (Figure 1). Our case shows that in case of recurrence of symptoms following cholecystectomy, clip migration should be considered in one ofthe differential diagnosis. This website uses cookies. Having said that, we encountered several cases where the migrated clips are located in close proximity to an organ that potentially can be perforated (Fig. Late complications include biliary strictures and post cholecystectomy clip migration (PCCM). The patient improved uneventfully following the procedure. Connectez-vous pour en bénéficier! Martinez J, Combs W, Brady PG. 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