복강경 담낭 절제술 후 간관 내에서 발견된 수술 클립: 총담관으로의 이동 경로인가?

• Published in: Annals of surgical treatment and research pp. 176 - 180
• Main Authors: 안승익, 이건영, 김세중, 조응호, 최선근, 허윤석, 조영업, 홍기천, 신석환, 김경래, 우제홍, 정석
• Format: Journal Article
• Language: Korean
• Published: 대한외과학회 01.08.2005
• Subjects: 일반외과학
• ISSN: 2288-6575; 2288-6796

Surgical clip migration and subsequent stone formation in the common bile duct is a rare, but well-established complication after laparoscopic cholecystectomy. There are some suggestions about the mechanisms of the migration process, but the details are still unclear. We report here on a case in which common bile duct stones were formed around surgical clips, and other clips were found to have penetrated into the common hepatic duct, which we believe were in the process of migration after laparoscopic cholecystectomy. The patient required a laparotomy to retrieve the bile duct stones due to the distal bile duct stricture, and another laparotomy was necessary to remove the penetrating clips, which were deeply embedded in the bile duct wall. Although a variety of endoscopic and percutaneous interventional procedures are available in this era of modern medical technology, it is sometimes impractical to apply these procedures in such cases as ours, and exploratory laparotomy is sometimes required to correctly treat the patient. This case shows that the metallic surgical clips can penetrate into the intact bile duct wall through serial maceration, and we believe that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy. KCI Citation Count: 1