Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases

Abstract

PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP.

Endoscopic removal of foreign body from hepatic duct using wire guided forceps and basket

“…Many of them are a result of migration of medical devices such as metallic clips after laparoscopic cholecystectomy 1,2 , embolization coil 1 , surgical silk suture 3 , fragmented plastic stent 4 and fractured guidewire 5 . These materials sometimes cause biliary colic 3 and bile duct obstruction 1 or predispose to biliary stone formation 2 , hence they should be removed. Usually, the less-invasive endoscopic method is preferred to remove the foreign bodies 1,3,4 .…”

“…These materials sometimes cause biliary colic 3 and bile duct obstruction 1 or predispose to biliary stone formation 2 , hence they should be removed. Usually, the less-invasive endoscopic method is preferred to remove the foreign bodies 1,3,4 . Percutaneous 1,5 or surgical intervention may be necessary if endoscopy failed 1 .…”

“…Usually, the less-invasive endoscopic method is preferred to remove the foreign bodies 1,3,4 . Percutaneous 1,5 or surgical intervention may be necessary if endoscopy failed 1 . For the endoscopic approach, long segment stricture or stenosis restricted the manipulation of the retrieval devices such as rat-tooth forceps, snare, basket and guidewire.…”

Cystic duct clip migration into the common bile duct

“…A recent literature review identified 80 reported cases (of which 69 were analyzed) of either clip migration or clip related stones [2]. The median time to recognition was 2 years after surgery and a majority of cases were managed successfully with ERCP [2].…”

“…The median time to recognition was 2 years after surgery and a majority of cases were managed successfully with ERCP [2]. Interestingly, 29% of these reports were associated with bile duct strictures, implying that bile duct injuries are probably associated with such cases.…”