The patient was successfully treated with endoscopic sphincterotomy plus balloon dilation (ESBD) and Hem-o-lok clips extraction. Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. September 2019; The American Journal of Gastroenterology; DOI: 10.14309/crj.0000000000000216 Data is temporarily unavailable. 1 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. This study reviews a case of postcholecystectomy clip migra-tion. Most of such incidents have been reported as case reports. B.  Valleix Migration of metal clips into the duodenum after laparoscopic cholecystectomy is rare. Initial investigations confirmed pyrexia and elevated bilirubin. During LC, surgical hemostatic clips placed on the cystic duct and … 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. Some error has occurred while processing your request. Éditions scientifiques et médicales Elsevier SAS. 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%). This website uses cookies. 4 5 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 … 10 The first case of PCCM was reported in 1978. The delay between laparoscopic cholecystectomy and the first symptoms due to cystic duct clip migration ranged from 5 to 12 months. D.  Cholangitis with a silver lining. Postcholecystectomy clip migration is rare and can lead to complications such as clip-related biliary stones. Register with us for free His temperature was 38.5°C, and his white blood cell count was 6.0 × 109 cells/L. © 2000  Clip migration into the common bile duct can cause recurrent cholangitis and serve as a nidus for stone formation. This study reviews a case of postcholecystectomy clip migration. We herein present two cases of migration of metal clips into the duodenum in patients who developed upper quadrant discomfort and a poor appetite after laparoscopic cholecystectomy. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Lippincott Journals Subscribers please login with your username or email along with your password. 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. Multiple cholecystectomy clip migration into the common bile duct causing obstructive jaundice 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]. Cholecystectomy Clip Migration and Retrieval. Balloon sphincteroplasty was performed, and the cholecystectomy clip and adherent sludge were successfully removed via a balloon sweep (Figure 3). The patient improved uneventfully following the procedure. Surgical clip migration into the common bile duct (CBD) is a rare complication after laparoscopic cholecystectomy (LC) [1, 2]. Try again. 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. Anesthésie, Réanimation, Médecine d'urgence, Biologie, Bactériologie, maladies infectieuses, Traitement chirurgical de la rectocèle antérieure de la femme.La voie périnéovaginale, Hémorragie digestive révélatrice d'un cancer du rein par métastases jéjunales multiples, P. Farthouat, S. Faucompret, C. Louis, P. Debourdeau, C. Pero, Y. Breda. It can occur at any time but typically occur at a median of 2 years after cholecystectomy. ,  Metallic clip migration in most cases is due to technical factors and can usually be prevented. The … 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 ]. Get new journal Tables of Contents sent right to your email inbox, Clinical and Translational Gastroenterology, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), September 2019 - Volume 6 - Issue 9 - p e00216, Cholecystectomy Clip Migration and Retrieval, Articles in PubMed by David Sanders, BSc, MD, Articles in Google Scholar by David Sanders, BSc, MD, Other articles in this journal by David Sanders, BSc, MD. All registration fields are required. Item Preview 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 ]. You may be trying to access this site from a secured browser on the server. For more information, please refer to our Privacy Policy. tion3 post-laparoscopic cholecystectomy, as well as migra-tion to more remote and dependent organs like ovary and causing symptoms.4 References 1. ACG Case Reports Journal6(9):e00216, September 2019. Informed consent was obtained for this case report. Registered users can save articles, searches, and manage email alerts. Biliary dilatation and strictures were encountered in 74.1% and 28.6%, respectively. Article gratuit. adhérons aux principes de la charte HONcode. J Gastrointest Surg. Cholecystectomy, that is removal of the gallbladder, is usually considered a safe operation, however there is a small risk of complications associated as is with all procedures. Correspondence: David Sanders, BSc, MD, Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1L9 ([email protected]). Case Report. Your message has been successfully sent to your colleague. 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. Surgical clips are applied during cholecystectomy on the cystic duct and artery. Migration of surgical clips is a rare complication of laparoscopic cholecystectomy, which can be a cause of iatrogenic Mirizzi syndrome . 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. EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925. Our case shows that in case of recurrence of symptoms following cholecystectomy, clip migration should be considered in one ofthe differential diagnosis. Keywords: Clip migration, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy, Mirizzi syndrome, Polymer laparoscopic clip, Post-cholecystectomy syndrome Background Gallstone disease is one of the most common digestive diseases; it affects over 10 % of the general population and leads to many cholecystectomies annually. Rarely one or more clips can get displaced. In one patient, the clip dropped from the duodenum after 2 months; the … 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]. An email with instructions to reset your password will be sent to that address. The clip itself may cause those symptoms without the formation of a stone, usually if the migration occurs within 3 months after the operation. [email protected]. We present herein the case of a woman who developed unexpected complications following a laparoscopic cholecystectomy. All rights reserved. We herein demonstrate a case of a migrated metal clip, which had been applied originally to the cystic duct, but thereafter had moved to the common bile duct. Sorry, the specified email address could not be found. ,  Clip-induced biliary stone. ,  Cetta F, Lombardo F, Baldi C, Cariati A. Most of such incidents have been reported as case reports. Background . This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. to maintaining your privacy and will not share your personal information without The time interval between the initial cholecystectomy and the development of complications due to endoclip migration varies from some days to 20 years. Surgical clips as a nidus for biliary stone formation: Diagnosis and therapy. Ligation of cystic artery and duct is usually performed with titanium surgical clips, which have the potential to migrate into the CBD with time and cause obstruction, stone formation, acute biliary pancreatitis, stenosis and cholangitis [ 2 , 3 ]. 4. La présence d'un canal cystique trop long [2] Walker W.E., Avant G.R., Reynolds V.H. 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