Schreuder Anne M, van Gulik Thomas M, Rauws Erik A J
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Case Rep Gastroenterol. 2018 Nov 28;12(3):686-691. doi: 10.1159/000493253. eCollection 2018 Sep-Dec.
Clips inserted during laparoscopic cholecystectomy (LC) may migrate into the biliary system and function as a nidus for the formation of gallstones. Here, we present a series of 4 patients who presented with this rare complication 5-17 years after LC. All 4 patients presented with symptomatic choledocholithiasis with biochemical and radiological signs of biliary obstruction. Three patients also had fever and infectious parameters, compatible with concurrent cholangitis. All patients successfully underwent endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and stone extraction. Patients with cholangitis also had antibiotic treatment. In 3 patients, obstruction of the common bile duct was caused by a single, relatively large stone that had formed around a clip (supposedly the cystic duct clip). In 1 patient, multiple stones had formed around an intrabiliary migrated cluster of coils that had been used for arterial embolization of a pseudo-aneurysm of the right hepatic artery. In conclusion, surgical clips and coils can migrate into the biliary tract and serve as a nidus for the formation of bile duct stones. Although rare, this complication should caution surgeons not to place clips "at random" during cholecystectomy. Patients with this rare complication are best managed by ERCP in combination with sphincterotomy and stone extraction.
腹腔镜胆囊切除术（LC）期间插入的夹子可能会迁移至胆道系统，并成为胆结石形成的病灶。在此，我们报告了4例患者，他们在LC术后5至17年出现了这种罕见的并发症。所有4例患者均表现为有症状的胆总管结石，并伴有胆道梗阻的生化和影像学征象。3例患者还伴有发热及感染指标，符合并发胆管炎的表现。所有患者均成功接受了内镜逆行胰胆管造影术（ERCP），并进行了乳头切开术和结石取出术。胆管炎患者还接受了抗生素治疗。3例患者的胆总管梗阻是由围绕一个夹子（推测为胆囊管夹子）形成的单个相对较大的结石所致。1例患者的胆管内有一团用于右肝动脉假性动脉瘤动脉栓塞的线圈发生迁移，周围形成了多个结石。总之，手术夹子和线圈可迁移至胆道，并成为胆管结石形成的病灶。尽管这种并发症罕见，但应提醒外科医生在胆囊切除术中不要“随意”放置夹子。对于这种罕见并发症的患者，最好采用ERCP联合括约肌切开术和结石取出术进行治疗。
