Abstract

Background: Surgical clips may migrate into the common bile duct after surgery for cholecystolithiasis leading to usually early or middle-term complications.
Case Report: 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.
Conclusions: 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. Defi nitive treatment of the
condition may be achieved through ERCP. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdomen.

Keywords: Abdomen, Acute - physiopathology, Cholecystectomy, Laparoscopic - instrumentation, Common Bile Duct - surgery, Foreign-Body Migration - radiography, Gallstones - etiology, Gallstones - radiography, Surgical Stapling - adverse effects, Abdomen, Acute - physiopathology, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic - instrumentation, Common Bile Duct - surgery, Foreign Bodies - surgery, Foreign-Body Migration - radiography, Gallstones - surgery, Surgical Instruments - adverse effects, Surgical Stapling - adverse effects, Time Factors