Korean J Gastroenterol.  2018 Dec;72(6):313-317. 10.4166/kjg.2018.72.6.313.

Abdominal Pain Due to Hem-o-lok Clip Migration after Laparoscopic Cholecystectomy

• Rou WS
• Joo JS
• Kang SH
• Moon HS
• Kim SH
• Sung JK
• Lee BS
• Lee ES

• KMID: 2429949
• DOI: http://doi.org/10.4166/kjg.2018.72.6.313

Abstract

During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip.

Keyword

Surgical instruments; Foreign-body migration; Cholecystectomy; Cholangiopancreatography, endoscopic retrograde

MeSH Terms

Abdominal Pain*
Arteries
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Cholecystectomy, Laparoscopic*
Common Bile Duct
Cystic Duct
Female
Foreign-Body Migration
Humans
Middle Aged
Surgical Instruments
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A, B) Abdominal sonogram showing an echogenic object (arrows) in the proximal CBD that appeared to change in shape when the probe direction was altered. CBD, common bile duct.

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  Fig. 2 Abdominal computed tomography image showing a tiny radio-opaque object (arrow) initially suspected to be a common bile duct stone.

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  Fig. 3 (A) Plain abdominal radiograph taken prior to endoscopic retrograde cholangiopancreatography showing two metallic clips (black arrow), which were thought to be clamping the cystic artery. However, no clip shadow was visible in the lower part of this X-ray corresponding to the expected location of the common bile duct. (B) Endoscopic retrograde cholangiography showed a linear filling defect (white arrow) in the distal common bile duct.

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  Fig. 4 (A, B) The Hem-o-lok clip was removed using a stone basket.

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