A rare complication following laparoscopic cholecystectomy; a case series

Abstract

Background: Foreign bodies such as coils and clips in the abdomen are known to migrate internally or externally. Pathophysiology is unknown but thought to be related to (sterile) inflammation. We present a case series of 4 patients who presented with CBD stones, years after cholecystectomy. Methods: Varying from 5 to 17 years after cholecystectomy, 4 patients presented themselves with symptomatic choledocholithiasis with biochemical and radiological signs of biliary obstruction. 2 patients also had fever and infectious parameters, indicating concurrent cholangitis. Results: Patients with cholangitis were treated with antibiotics. All patients successfully underwent ERCP with papillotomy and stone extraction. In 3 patients, obstruction of CBD was caused by a single, relatively large stone that had formed around a clip (supposedly the cystic duct clip). In one patient, multiple stones had formed around a cluster of coils that had been used for arterial embolization and that had migrated into the bile duct. Conclusion: Foreign bodies can migrate into the biliary tract and function as a nidus for the formation of gallstones. Extraction of clips and stones by ERCP is treatment of choice as proved successful in all of our 4 patients.