Surgical clips metal allergy postlaparoscopic cholecystectomy

Abstract

Introduction: Surgical clips and staples are the mainstay of wound closure in a multitude of surgical procedures such as cholecystectomies. These clips/staples are composed of a variation of different elements including titanium, aluminum, cobalt, and nickel—all of which can lead to type IV hypersensitivity reactions. Adverse effects of these hypersensitivities triggered through the release of mast cells and basophils can occur resulting in the development of atopic dermatitis, stomatitis, erythema, urticaria, and edema. Presentation of case: We present a rare case of a patient who underwent cholecystectomy involving the use of metal surgical clips with adverse reactions. Postoperatively the patient complained of an array of symptoms including abdominal pain, fatigue, lethargy, joint aches, and nausea. The pain remained out of proportion to testing modalities, which time and time again were unremarkable. Following the withdrawal of the surgical clips the patients’ symptoms have resolved and remain in remission. Discussion: Preoperative screening for metal allergies albeit rare can result in prevention of long-term adverse effects, as was the case with our patient. A detailed patient history and report can demonstrate any need for further testing. Patients should be advised of any and all side effects of surgical procedures including those that may occur as a result of hypersensitivity reactions to surgical clips and staples. Proper patient education can alert a patient with any triggering symptoms to receive prompt medical attention to prevent progression of infection and disease. Postoperative follow up is also recommended to allow both the patient and the physician to ensure the prevention of any arising complications both short and long term. Conclusion: Proper preoperative history and physical examination warrants the detection of any pertinent allergies to metals, as well as other compounds. This allows for proper surgical approach. Surgeons may change their method and use other wound healing techniques involving sutures instead. Long-term adverse effects can be avoided ensuring proper patient healing and follow up.