Endoscopic management of a major bile duct stricture from surgical clips following laparoscopic hemicolectomy.

Benign postoperative bile duct strictures are usually complications of cholecystectomies. However, development of obstructive jaundice and biliary stricture as a result of surgical clips after laparoscopic right hemicolectomy is rare and has not been reported in the literature. We present a case of a 64-year-old woman who presented with sudden onset jaundice and abdominal pain, 1 week following right hemicolectomy. Laboratory reports suggested obstructive jaundice. Subsequent imaging studies showed biliary dilation of both intrahepatic and extrahepatic ducts with no evidence of bile duct stones. The endoscopic retrograde cholangiopancreatography (ERCP) showed an abrupt, complete obstruction of the common bile duct at the level of the surgical clips. The bile duct stricture formed at the site of surgical clips improved significantly after serial incremental biliary dilations with successive placement of increasing number of endoprostheses side-by-side at repeat ERCP sessions.