Woodward Zachary K, Sivasuthan Goutham, Lim Chee Hua, Aseervatham Ratna
General Surgery, Sunshine Coast University Hospital, Birtinya, AUS.
Gastroenterology, Sunshine Coast University Hospital, Birtinya, AUS.
Cureus. 2024 Dec 23;16(12):e76275. doi: 10.7759/cureus.76275. eCollection 2024 Dec.
Cholecystectomy is one of the most commonly performed surgical operations worldwide. A rare complication following this procedure is the migration of surgical clips used to secure the cystic duct and artery. Herein, we report the migration of a metallic surgical clip into the common bile duct of a 75-year-old gentleman who underwent a laparoscopic cholecystectomy 24 years prior. He presented to the hospital three times over the course of six months with the predominant symptoms of right upper quadrant pain. His symptoms improved with supportive care during his first two admissions, and he was discharged home with a plan for ongoing investigation. Subsequent endoscopic ultrasound and magnetic resonance imaging did not identify a cause for his symptoms. On his third presentation to the hospital, he had mild transaminitis with elevated bilirubin and his computed tomography scan revealed migration of a surgical clip into the distal common bile duct where it was causing obstruction. As he was also symptomatic with influenza A and at a heightened anaesthetic risk, a conservative management approach was taken instead of upfront endoscopic retrograde cholangiopancreatography for clip retrieval. Over the coming days, his bilirubin and liver function tests began to normalise and the offending clip was not identified on a repeat computed tomography scan performed three days later, indicating spontaneous passage of the clip from the common bile duct. On re-review of the initial imaging, the surgical clip can be seen within the remnant cystic duct prior to its migration into the distal common bile duct. Surgical clip migration is an exceedingly uncommon occurrence, and this case highlights the difficulty of establishing the diagnosis despite extensive investigation. Increased awareness of this phenomenon among clinicians will hopefully aid in earlier diagnosis and improved outcomes for patients.
胆囊切除术是全球最常进行的外科手术之一。该手术后一种罕见的并发症是用于固定胆囊管和动脉的手术夹移位。在此，我们报告一例金属手术夹移位至胆总管的病例，患者为一名75岁男性，24年前接受了腹腔镜胆囊切除术。在六个月的时间里，他三次入院，主要症状为右上腹疼痛。在前两次入院期间，通过支持性治疗他的症状有所改善，出院时计划进行进一步检查。随后的内镜超声和磁共振成像均未发现其症状的病因。在他第三次入院时，出现轻度转氨酶升高和胆红素升高，计算机断层扫描显示一个手术夹移位至胆总管远端并造成梗阻。由于他同时患有甲型流感且麻醉风险较高，因此采取了保守治疗方法，而非直接进行内镜逆行胰胆管造影取夹。在接下来的几天里，他的胆红素和肝功能检查开始恢复正常，三天后复查计算机断层扫描未发现肇事手术夹，表明该手术夹已从胆总管自行排出。重新审视最初的影像学检查时，可以看到手术夹在移位至胆总管远端之前位于残余胆囊管内。手术夹移位是一种极其罕见的情况，该病例凸显了尽管进行了广泛检查但仍难以确诊的问题。临床医生对这一现象的认识提高有望有助于早期诊断并改善患者的治疗效果。
