Hussameddin Anas M, AlFawaz Iba Ibrahim, AlOtaibi Reema Fahad
Department of Internal Medicine, King Fahd University Hospital, Khobar, Saudi Arabia.
College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, Saudi Arabia.
Case Rep Gastrointest Med. 2018 May 13;2018:5892143. doi: 10.1155/2018/5892143. eCollection 2018.
Surgical clip migration into the common bile duct with subsequent stone formation is a rare complication following laparoscopic cholecystectomy. Very few cases have been reported in the literature. We report a case of bile duct stone formation around a migrated surgical clip 16 years after laparoscopic cholecystectomy. The patient presented with right upper quadrant pain, fever, and chills for one week. Investigation with abdominal ultrasound showed dilatation of the common bile duct and moderate dilatation of the intrahepatic bile ducts. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and the patient was managed successfully with sphincterotomy and stone extraction. The exact mechanism of clip migration is not fully understood. Presenting symptoms are similar to non-clip-induced choledocholithiasis. Time of presentation can vary significantly with an average of 26 months. Most cases reported in the literature required surgical intervention. Clip migration should be considered in the differential diagnosis of postcholecystectomy biliary colic and cholangitis. Management with endoscopic retrograde cholangiopancreatography is the treatment of choice.
手术夹移位至胆总管并继发结石形成是腹腔镜胆囊切除术后一种罕见的并发症。文献中报道的病例极少。我们报告一例腹腔镜胆囊切除术后16年，移位的手术夹周围形成胆管结石的病例。患者出现右上腹疼痛、发热和寒战一周。腹部超声检查显示胆总管扩张及肝内胆管中度扩张。经内镜逆行胰胆管造影术确诊，患者通过括约肌切开术和结石取出术成功治愈。手术夹移位的确切机制尚不完全清楚。其表现症状与非手术夹所致的胆总管结石症相似。出现症状的时间差异很大，平均为26个月。文献中报道的大多数病例需要手术干预。在胆囊切除术后胆绞痛和胆管炎的鉴别诊断中应考虑手术夹移位。经内镜逆行胰胆管造影术是首选的治疗方法。
