Surgical clip migration following laparoscopic cholecystectomy as a cause of cholangitis
A 42-year-old male with a history of cerebral palsy, learning difficulties and epilepsy was admitted with a 24-h history of nausea, vomiting and abdominal pain. Past surgical history included laparoscopic cholecystectomy with operative cholangiogram 9 years previously and laparotomy and drainage of a pancreatic pseudocyst 16 years previously.\nExamination revealed a midline laparotomy scar and a distended, tender abdomen.\nLaboratory tests revealed elevated liver function tests: ALP 285 U/l, ALT 465 U/l, GGT 669 U/l with a normal bilirubin. Magnetic resonance cholangiopancreatography demonstrated marked dilatation of the common bile duct to 15 mm (Fig. ). A surgical clip was noted in the distal common bile duct, presumed to have migrated from the cystic duct, which it had been used to close 9 years previously.\nThe patient had an ERCP and sphincterotomy during which the clip was removed leading to complete resolution of symptoms and return of biochemical markers to normal.