World Congress of Gastroenterology, İstanbul, Türkiye, 21 - 24 September 2019, cilt.30, ss.493-494
Acute pancreatitis and cholangitis due to migrating surgical clips into common bile duct
Cem Aygün, Aysun Bozbaş, Nesliar Eser Kutsal, Nurdan Tozun
Department of Internal Medicine and Gastroenterology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul,
Biliary tract related conditions are among the most common disorders that require hospitalization in gastroenterology
units. While majority of patients with incidental gallbladder stones will not develop symptoms, approximately 15-25% might become symptomatic during follow-up. The presenting symptoms are highly variable and unlike gallbladder stones most patients with common bile duct stones develop symptoms. Surgical clip migration into common bile duct is a rare complication after cholecystectomy. It may lead to stone formation, obstruction, stricture, cholangitis and pancreatitis.
Patients with acute cholangitis or pancreatitis due to surgical clip migration and common bile duct obstruction
Turk J Gastroenterol 2019; 30(Suppl 3): S137-S912 World Congress of Gastroenterology Abstracts
who have signs of septic shock require urgent biliary decompression. A 81-year-old male patient was admitted to our emergency department with recurrent jaundice for 2 weeks. He had nausea and upper abdominal pain for 2 days with high-grade intermittant fever starting just before the day of admission. There was mild pruritis all over the body. He had laparoscopic cholecystectomy (LC) for acute calculous cholecystitis 3 months ago. In his history there was no any other systemic disease other than hypertension. On physical examination, there was yellowish pigmentation of the skin and sclerae due to suspected high bilirubin levels. He had a temperature of 38.50C with tachycardia (heart rate: 115/minute). Previous LC scares were seen on abdominal wall on inspection. There was marked tenderness of epigastric area and right upper quadrant region during palpation. Prompt laboratory analysis revealed the following results: Hemoglobin (Hb) level, 11 g/ dL (normal 13.5-17 g/dL); white blood cell (WBC) count, 15.6×103/μL (normal 4.1-10.6×103/μL); platelet (PLT) count, 153×103/μL (normal 159-388×103/μL); neutrophil count, 13.5×103/μL (1.9-7×103/μL), and C-reactive protein
(CRP) level, 11.3 mg/dL (normal 0-0.5 mg/dL). Alanine aminotransferase (ALT) 276 U/L (normal up to 59), aspartate aminotransferase (AST) 169 U/L (normal up to 37), gamma glutamyl transpeptidase (GGT) level, 633 U/L (normal up to 55), and total bilirubin 6.4 mg/dL (normal up to 1.2). Serum amylase was 2250 U/L (normal up to 115) and serum lipase was 18108 U/L (normal up to 393). Magnetic resonance cholangiopancreatography (MRCP) showed dilated common bile duct with suspected calculi and sludge inside. An urgent endoscopic retrograde cholangiopancreatography (ERCP) was performed. Cholangiogram revealed dilated intra and extrahepatic biliary tree with distal suspected calculi or sludge. Sphincterotomy was done initially and then by using exraction balloon two surgical clips were removed from the common
bile duct. Pain and fever promptly disappeared after the ERCP with progressive decrease in amilase, lipase and liver functions tests. Patient was discharged in good condition after 5 days of hospitalization. With this case we aimed to report that surgical clip migration into common bile duct can be seen as a leading cause of obstruction, cholangitis and pancreatitis. ERCP can be performed succesfully and safely in the treatment of the migrated surgical clips before clinical detoriation occurs.
Keywords: Migrating surgical clips, acute pancreatitis, acute cholangitis