Migration of vessel clip into the common bile duct and late formation of choledocholithiasis after laparoscopic cholecystectomy

Since the first silk suture material acting as a nidus for the development of subsequent common bile duct stones after cholecystectomy was described in 1897, several investigators have reported that suture materials may cause choledocholithiasis. Silk, chromic catgut, parasites, and other foreign bodies are known occasionally to form such niduses in the common bile duct. Surgical hemostatic clips have been used widely and generally are considered very safe. The first case of postcholecystectomy clip migration was reported in 1979. Its exact pathogenesis remains unknown; it generally is agreed that bile duct injuries, inappropriate clip placements, subclinical bile leak, and infections also have been postulated to contribute to clip migration. We report an unusual case in which the core of a biliary calculus in the common bile duct was found to contain a surgical clip. This case illustrates the potentially abrupt and late development of clip-related gallstones and highlights the need for long-term follow-up evaluation. (C) 2011 Elsevier Inc. All rights reserved.