Bile duct "clip-stones"--why a stitch in time could save nine.

A 32 year old female patient underwent laparoscopic cholecystectomy and in the post-operative phase was investigated after developing obstructive jaundice. ERCP revealed a stenosis at the junction of the cystic and common hepatic ducts and this was seen to be directly adjacent to the clips which had been used to ligate the cystic duct. The stricture was easily dilated with a balloon and all her symptoms improved and her liver function tests returned to normal. Eight years later she represented with a mid-common bile duct calculus. An ERCP was performed but the stone could not be dislodged or retrieved and when removed subsequently at open exploration it was found to have precipitated around two metal clips, which had migrated into the lumen of the common bile duct. We propose that the risk of this rare, yet previously reported complication, could be reduced by heeding the longstanding recommendation that only absorbable material be used in biliary surgery, and particularly when there is a short cystic duct.