Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases

Hemoclip migration after revision carpal tunnel release: a case report

A 22-year-old female presented to our clinic with the redevelopment of compressive symptoms after undergoing right carpal tunnel release 2 years prior. During revision surgery, the application of a chitosan polysaccharide membrane wrap over the median nerve was secured with three hemoclips. Follow-up revealed that these clips traveled distally to the volar aspect of the patient's small finger necessitating excision. Hemoclips in hand surgery serve as a useful tool for securing constructs; however, the recommendation to use them sparingly is made because of the potential for migration and exacerbation of symptoms.

Hem-o-lok clip migration to the common bile duct after laparoscopic common bile duct exploration: A case report

BACKGROUND

Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) has been widely used for management of gallbladder and common bile duct (CBD) stones. Post-operative clip migration is a rare complication of laparoscopic biliary surgery, which can serve as a nidus for stone formation and cause recurrent cholangitis.

CASE SUMMARY

A 59-year-old female was admitted to hospital because of fever and acute right upper abdominal pain. She has a history of LC and had a LCBDE surgery 2 mo ago. Physical examination revealed tenderness in the upper quadrant of right abdomen. Computed tomography scan demonstrated a high-density shadow at the distal CBD, which was considered as migrated clips. The speculation was confirmed by endoscopic retrograde cholangiopancreatography examination, and two displaced Hem-o-lok clips were removed with a stone basket. No fever or abdominal pain presented after the operation. In addition to the case report, literature regarding surgical clip migration after laparoscopic biliary surgery was reviewed and discussed.

CONCLUSION

Incidence of postoperative clip migration may be reduced by using clips properly and correctly; however, new methods should be explored to occlude cystic duct and vessels. If a patient with a past history of LC or LCBDE presents with features of sepsis and recurrent upper quadrant pain, clip migration must be considered as one of the differential diagnosis.

Acute Cholangitis Secondary to Surgical Clip Migration 18 Years After Cholecystectomy: A Case Report

Gallstone disease is a common condition and reason for consultation and hospitalizations. The standard of care is laparoscopic cholecystectomy. Early complications include bile duct injury and retained stone, and chronic complications include bile duct stricture and clip migration. It is important for clinicians to be aware of such complications as they can occur long after surgery. We report an interesting case of clip migration resulting in acute cholangitis, 18 years after laparoscopic cholecystectomy and review the literature on this interesting phenomenon of a commonly performed surgery. The diagnosis of clip migration in our case was suspected on abdominal radiograph and confirmed on endoscopic stone extraction.