Surgical clip as a nidus for common bile duct stone formation and successful endoscopic therapy

Choledochal stenosis and lithiasis caused by penetration and migration of surgical metal clips

“…This biloma probably drained off later into the common bile duct via the cystic duct. Others suggested that erosion of the bile duct wall occurred secondary to a localized inflammatory process, resulting in the erosion of the clips into the ductal system, where gallstone formation occurred. In the present patient, we considered the following pathogenesis.…”

Surgical clip as a nidus for a common bile duct stone: radiographic demonstration

“…In the first reported case in 1897, silk sutures served as the nidus for gallstone formation after cholecystotomy [1]. In more recent reports, metallic surgical clips migrate into the biliary tract and act as a nidus for stone formation [2][3][4][5][6][7][8].…”

“…A central metallic density within the biliary tract in association with biliary obstruction confirms the presence of a clip stone, although mistaking a surgical clip for bile duct stone calcification is possible. Endoscopic retrograde cholangiography is essential for the evaluation of choledocholithiasis and can confirm the presence of a surgical clip within a biliary tract calculus and guide endoscopic therapy for stone removal [4][5][6].…”

“…The formation of biliary calculi around migrated surgical material after cholecystectomy is an unusual cause of choledocholithiasis [1][2][3][4][5][6][7][8]. With the increasing use of metallic surgical clips, especially in laparoscopic procedures, this complication is more prevalent [5].…”

New anastomosis technique for (laparoscopic) instrumental small-diameter anastomosis

“…The final anastomosis is completely free of any foreign material. This is specifically desirable for anastomosis of the bile ducts, as a foreign body might lead to the formation of bile concretions [6]. But also for colonic anastomosis in Crohn's disease it is advantageous not to use foreign material.…”