Published online Apr 28, 2014. doi: 10.3748/wjg.v20.i16.4827
Revised: January 20, 2014
Accepted: March 4, 2014
Published online: April 28, 2014
The wide use of surgical endoclips in laparoscopic surgery has led to a variety of complications. Post-cholecystectomy endoclips migrating into the common bile duct after laparoscopic cholecystectomy is rare. A migrated endoclip can cause obstruction, serve as a nidus for stone formation, and cause cholangitis. While the exact pathogenesis is still unknown, it is probably related to improper clip application, subclinical bile leak, inflammation, and subsequent necrosis, allowing the clips to erode directly into the common bile duct. We present a case of endoclip migrating into the common bile duct and duodenum, resulting in choledochoduodenal fistula after laparoscopic cholecystectomy and a successful reconstruction of the biliary tract by a hepaticojejunostomy with a Roux-en-Y procedure. This case shows that surgical endoclips can penetrate into the intact bile duct wall through serial maceration, and it is believed that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy.
Core tip: Choledochoduodenal fistula caused by endoclip migration; an extremely rare complication after the introduction of laparoscopic cholecystectomy which can occur from days to years after laparoscopic cholecystectomy.