Surgical Clip Migration Following Laproscopic Cholecystectomy as a Cause of CBD Stone (original) (raw)

Bile leakage presenting as acute abdomen due to a stone created around a migrated surgical clip

Medical science monitor : international medical journal of experimental and clinical research, 2005

Surgical clips may migrate into the common bile duct after surgery for cholecystolithiasis leading to usually early or middle-term complications. A 31-year-old woman, 6 years after laparoscopic cholecystectomy, developed acute abdomen and choloperitoneum after rupture of a secondary bile duct and bile leakage. This complication was due to a solitary common bile duct stone. The stone was formed around a surgical clip that had migrated from the cystic duct remnant to the common bile duct. The patient underwent investigative laparotomy and, subsequently, an ERCP with stone extraction and clearance of the common bile duct. She was perfectly well at the follow-up after 14 months. Rupture of a bile duct and biliary peritonitis may be a delayed complication of laparoscopic cholecystectomy due to surgical clip migration and formation of a stone. Definitive treatment of the condition may be achieved through ERCP. Surgeons, gastroenterologists and radiologists should be aware of this late com...

Fortuitous discovery of common bile duct stones: Results of a conservative strategy

Gastroentérologie Clinique et Biologique, 2008

Objective. -The incidence of fortuitously discovered stones in the common bile duct is about 5%. The purpose of this study was to determine the rate of spontaneous clearance of asymptomatic stones in the common bile duct discovered fortuitously during cholecystectomy. Patients and methods. -Intraoperative cholangiography was performed in all patients undergoing cholecystectomy for symptomatic gallbladder stones. If a filling defect of the common bile duct was discovered, a transcystic drain was inserted. Surgical or endoscopic extraction was not proposed initially. A control cholangiogram was performed on the second postoperative day then during the sixth postoperative week. If a stone persisted at the sixth week, endoscopic extraction was undertaken.

7251 Natural history of asymptomatic bile duct stones at time of cholecystectomy

Gastrointestinal Endoscopy, 2000

Objectives: There is little data on the natural history of asymptomatic bile duct stones and hence there is uncertainty on the management of asymptomatic bile duct stones discovered incidentally at the time of laparoscopic cholecystectomy. We retrospectively reviewed a group of patients who had previously underwent laparoscopic cholecystectomy, but who did not have a pre-operative suspicion of intra-ductal stones, to determine if any biliary complications had subsequently developed.A group of patients who had no pre-operative suspicion of intra-ductal stones, but routinely underwent intraoperative cholangiogram (IOC) at time of cholecystectomy, served as the control group. Methods: A telephone questionnaire was completed by each patient's family practitioner in 59 of 79 (75%) patients who underwent laparoscopic cholecystectomy. In the remaining 20 patients additional information was obtained from hospital records and from the central services agency (CSA). These patients had no pre-operative suspicion of bile duct stones and therefore did not undergo an IOC or ERCP. The control group (73 patients) had no pre-operative suspicion of bile duct stones but had a routine IOC performed to define the biliary anatomy. Results: 59 patients were followed up for an average of 57 months (range 30 -78 months) after laparoscopic cholecystectomy. None of these patients developed pancreatitis, jaundice, deranged liver function tests (LFT's), or required ERCP or other biliary intervention. In the additional 20 patients where no information was available from the family practitioner, 11 patients had follow up appointments with no documentation of biliary complications or abnormal LFT's. 19 of 20 patients were traceable through the CSA and were all alive. Only 1 patient was untraceable and therefore unknown if biliary complications had developed. In the control group, 4 of 73 (6%) patients had intraductal stones detected and extracted. Thus the prevalence of asymptomatic bile duct stones during the time of cholecystectomy in our population was 6%. Conclusions: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed.

Laparoscopic management of common bile duct stones

European Journal of Surgery, 2000

Introduction: Common Bile Duct stones (CBD) are found in approximately 16% of the patients undergoing Laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones was endoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the best treatment for CBD stones is a matter of debate and it continues to evolve. The objective of the present study is to determine that laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stage option for the management of CBD stones. Materials and Methods :Out of the 2900 laparoscopic cholecystectomies we did selective intraoperative cholangiogram in 262 patients who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with or without CBD stone on sonography or having the history of recent jaundice/pancreatitis. If CBD stone was found, either a transcystic or transcholedochal exploration was done depending on the size, site, number of stones and CBD diameter. Choledochotomy was closed over a t-tube in the majority of the patients. Primary closure of CBD was done in few patients and in one patient we placed an antegrade stent and in another we placed endoscopic stent into the CBD laparoscpically which was removed after four weeks. Results :Till date we have performed LCBDE in 64 patients. Transcystic exploration was done in 14 patients and transcholedochal exploration was done in 46 cases out of which 2 patients had minor biliary leak which settled on conservative treatment in 2-3 days. Four patients required conversion to open surgery as there were multiple stones. We did not have any major complication and on 6 months follow-up in 76% patients, none was found to have residual stone. Conclusion :The treatment of CBD stones depends on the resources available, technical limitations and the surgeon's expertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the management of CBD stones.

Common bile duct stones, an experience in Ondokuz Mayis University

Journal of Experimental and Clinical Medicine, 2013

Common bile duct stones, obstructive jaundice, cholangitis and acute pancreatitis are diseases that can lead to serious complications. In our clinic between May 1993 and October 2011 the results of 101 patients who underwent surgery for common bile duct stone were retrospectively evaluated. Among 101 patients who were included in the study, 45 had symptomatic gallstones accompanied by common bile duct stone, 27 had mechanical icterus, 15 had common bile duct stone and 8 had cholangitis (five patients with suppurative cholangitis), six had acute cholecystitis. Thirthy one patients with common bile duct stones were treated with endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were as follows; choledochoduodenostomy in 50 cases, T-tube drainage in 17 patients and transduodenal sphincteroplasty in three patients. Synchronous cholecystectomies were performed in all patients who had not undergone biliary surgery before. Early postoperative mortality was 3.9%. In this study, we detected choledocholithiasis in 11.31% of the all symptomatic cholelithiasis cases. Since our clinic provide tertiary healthcare, this rate becomes 9.85% by excluding those who underwent cholecystectomy for common bile duct stones at other hospitals. Given that the patients who referred to our clinic are in high-risk group, the actual rate of choledocholithiasis in our society is expected to be slightly below that value.