Percutaneous removal of migratory intrabiliary surgical clips

Abstract

To describe the technique of percutaneous removal of migratory intrabiliary surgical clips. Materials and methods: A 33-year-old male was admitted with recurrent cholangitis following choledochojejunostomy formation. Percutaneous transhepatic cholangiography demonstrated stricture at the hepaticojejunostomy and multiple intrabiliary surgical clips, two of which were mobile. Endoscopic retrograde cholangiopancreatography was not feasible due to the previous surgery. Balloon angioplasty of the choledochojejunostomy anastomosis was performed, followed by removal of the mobile surgical clips via a percutaneous tract. After dilatation of the tract, choledochoscopy, steerable catheters and angled tip catheters facilitated placement of a guidewire beyond the clips within a peripheral radicle. A Fogarty type balloon was then placed over the guidewire beyond the clip, enabling withdrawal of the balloon and clip into a sheath. Results: The two mobile migrated intrabiliary surgical clips were successfully removed using this technique. A 14F biliary Cope loop was placed across the choledochojejunostomy stricture for interim management, while the patient’s symptoms settled. Conclusion: Migratory intrabiliary surgical clips are important to detect to prevent stone formation or obstruction. Removal is usually via per oral endoscopy. We describe a percutaneous technique for the removal of such foreign bodies when an endoscopic approach fails or is not possible.