Gallstone Caused by Migration of Cystic Duct Metal Clips into the Common Bile Duct

Kazutaka Obama, Yoshiaki Nakamura, Hiroki Hashida and Arimichi Takabayashi

Department of Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute

We experienced a rare case of choledocholithiasis caused by metal clips which were engaged at the site of a previous laparoscopic cholecystectomy (Lap. C) performed nine months before. The patient was a 53 year-old-woman with cholecystolithiasis, who underwent the Lap. C in another hospital in April, 1995. The operation was converted to an open cholecystectomy to stop bleeding from the liver bed at the time of surgery. During the follow-up period, the patient suffered from intermittent high fever and abdominal pain. In January, 1996, endoscopic retrograde cholangiography revealed a stone shadow with metal clips in the common bile duct (CBD), and a stenotic lesion in the middle portion of the CBD. Surgery was subsequently performed on March 8, 1996 (11 months after the initial operation). The CBD was explored and the stone was removed. The stone appeared to be a pigmented gall stone with a nidus comprised of the metal clips used in the Lap. C.We performed a hepaticoduodenostomy, and the patient had an uneventful recovery, and maintained good bile flow. Surgical clips have previously been reported to form choledochal stones. In this case, the clips were located at the end of the cystic duct near the juncture with the CBD. Surgeons must exercise caution in the use of metal clips and electric cauterization to avoid damage to the CBD, which can result in local inflammation around the CBD.

Key words
laparoscopic cholecystectomy, choledocholithiasis, metal clip

Reprint requests
Kazutaka, Obama Department of Surgery, Kitano Hospital 13-3 Kamiyama-cho, Kita-ku, Osaka, 530-0026 JAPAN

Accepted
November 30, 1999

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