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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1809968
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Surgical Clip Migration into the Common Bile Duct Decades After Laparoscopic Cholecystectomy: A Rare Cause of Obstructive Jaundice

Kobina Essilfie-Quaye 
1   Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
2   Department of Internal Medicine, HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, United States
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
,
Amir Akhavan-Yazdi
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
4   Digestive Disease Associates, Gastroenterology Division, Gainesville, Florida, United States
,
Carson Creamer 
1   Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
2   Department of Internal Medicine, HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, United States
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
,
Harsimran Kalsi
1   Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
2   Department of Internal Medicine, HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, United States
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
,
Mohammad AbuAssi
1   Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
2   Department of Internal Medicine, HCA Florida North Florida Hospital, Internal Medicine Residency Program, Gainesville, Florida, United States
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
,
Ronald Lee
1   Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
3   Department of Gastroenterology, HCA Florida North Florida Hospital, Gainesville, Florida, United States
4   Digestive Disease Associates, Gastroenterology Division, Gainesville, Florida, United States
› Author Affiliations
Funding This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
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Brief Description

A 53-year-old woman with a remote history of laparoscopic cholecystectomy (LC) presented with nonspecific abdominal pain, jaundice, and cholestatic liver enzyme elevation nearly 30 years after surgery. A computed tomography (CT) scan showed a metallic density in the distal common bile duct (CBD), confirmed on magnetic resonance cholangiopancreatography (MRCP) to be a migrated surgical clip. She underwent endoscopic retrograde cholangiopancreatography (ERCP), which showed a migrated surgical clip embedded within a CBD stone. Successful endoscopic sphincterotomy and balloon extraction removed the clip–stone complex, with complete resolution of her symptoms and normalization of liver function tests.

Surgical clip migration into the CBD is a rare and delayed complication of LC. The migrated clip may act as a nidus for choledocholithiasis, leading to complications such as obstructive jaundice, acute cholangitis, or acute pancreatitis. Due to the nonspecific presentation and decades-long latency, a high index of suspicion and timely imaging are essential in postcholecystectomy patients presenting with biliary symptoms. CT or MRCP facilitates diagnosis, whereas ERCP remains the diagnostic and therapeutic modality of choice.

Author's Contributions

K.E.-Q. contributed to the writing of the original draft. R.L. was responsible for conceptualization and provided supervision throughout the project. C.C., H.K., M.A., and A.A.-Y., contributed to the review and editing of the manuscript. R.L. provided supervision and critical feedback. All authors reviewed and approved the final version of the manuscript before submission.


Patient's Consent

Written informed consent was obtained from the patient for the publication of this case report, including relevant clinical data and images. All patient identifiers have been removed to ensure confidentiality.




Publication History

Article published online:
02 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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