Iatrogenic biliary stone.

Biliary stone disease is a common disorder, usually associated with stones in the gallbladder, and can cause significant complications. Formations of stone usually occur in the presence of the following factors: abnormalities of the bile constituents, bile stasis, and the presence of nidus for stone formations. Numerous reports exist of foreign bodies (FBs) acting as nidus for stone formations within the biliary system. The FBs reported include surgical sutures, surgical clips, fragments of metal and plastics, ingested materials, and parasites. Surgical clips are reported to be the most commonly reported FBs that induce iatrogenic biliary stones. Surgical clips migration with subsequent stone formation is a well-recognized phenomenon since first used in surgery. Patients typically are first seen with symptoms of biliary obstruction and can be complicated by life-threatening cholangitis. These can occur from days to years after the initial surgical procedures. The underlying mechanism of the way in which FBs-including surgical clips-end up in the biliary system is unknown. Direct introduction during surgery, penetrating injuries, entero-bilio reflux, or erosions with eventual migration into the biliary system have been postulated. Bile-duct injuries, inappropriate clip placements, sub-clinical bile leak, and infections also have been postulated to contribute to clip migration. This Chapter reviews the literature regarding iatrogenic biliary stones as a result of FBs, and discusses the likely mechanisms involved with their migrations, stone formations, clinical presentations, and managements.