Liu HY, Yin AH, Wei Z. Hem-o-lok clip migration to duodenal bulb post-cholecystectomy: A case report. World J Gastrointest Surg 2024; 16(5): 1461-1466 [PMID: 38817275 DOI: 10.4240/wjgs.v16.i5.1461]
Corresponding Author of This Article
Zhi Wei, Doctor, MD, Associate Chief Physician, Department of Gastroenterology, Shandong Second Provincial General Hospital, No. 4 Duanxing West Road, Jinan 250022, Shandong Province, China. bj-1256@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2024; 16(5): 1461-1466 Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1461
Hem-o-lok clip migration to duodenal bulb post-cholecystectomy: A case report
Hong-Yan Liu, Ai-Hong Yin, Zhi Wei
Hong-Yan Liu, Ai-Hong Yin, Zhi Wei, Department of Gastroenterology, Shandong Second Provincial General Hospital, Jinan 250022, Shandong Province, China
Author contributions: Liu HY performed the manuscript writing and editing; Yin AH collected the patient’s clinical data; Wei Z provided the report conceptualization and supervision; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi Wei, Doctor, MD, Associate Chief Physician, Department of Gastroenterology, Shandong Second Provincial General Hospital, No. 4 Duanxing West Road, Jinan 250022, Shandong Province, China. bj-1256@163.com
Received: February 6, 2024 Revised: March 13, 2024 Accepted: April 10, 2024 Published online: May 27, 2024 Processing time: 106 Days and 20.4 Hours
Abstract
BACKGROUND
Hem-o-lok clips are typically used to control the cystic duct and vessels during laparoscopic cholecystectomy (LC) and common bile duct exploration for stones in the bile duct and gallbladder. Here, we report a unique example of Hem-o-lok clip movement towards the duodenal bulb after LC, appearing as a submucosal tumor (SMT). Additionally, we provide initial evidence of gradual and evolving endoscopic manifestations of Hem-o-lok clip migration to the duodenal bulb wall and review the available literature.
CASE SUMMARY
A 72-year-old man underwent LC for gallstones, and Hem-o-lok clips were used to ligate both the cystic duct and cystic artery. Esophagogastroduodenoscopy (EGD) 2 years later revealed an SMT-like lesion in the duodenal bulb. Due to the symptomatology, the clinical examination did not reveal any major abnormalities, and the patient was followed up as an outpatient. A repeat EGD performed 5 months later revealed an SMT-like lesion in the duodenal bulb with raised edges and a central depression. A third EGD was conducted, during which a Hem-o-lok clip was discovered connected to the front side of the duodenum. The clip was extracted easily using biopsy forceps, and no complications occurred. Two months after the fourth EGD, the scar was surrounded by normal mucosa.
CONCLUSION
Clinicians should be aware of potential post-LC complications. Hem-o-lok clips should be removed if symptomatic.
Core Tip: Migration of Hem-o-lok clips to the duodenal bulb may manifest as a slightly raised lesion resembling a submucosal tumor in the duodenal bulb. A gradual alteration in the endoscopic view of the lesion could be seen as the Hem-o-lok clip migrates through the wall of the duodenal bulb. Although Hem-o-lok clip migration to the duodenal bulb is infrequent, clinicians must be highly attentive and vigilant regarding these complications to avoid misdiagnosis.
